I’m still not impressed with Tekturna (aliskiren)

One of my more popular posts has been “Do we need Tekturna (aliskiren)?“. The comments have been varied, but I still stand by my doubts over its usefulness. Other medbloggers have expressed their doubts as well. And I should state right now that I think Tekturna being on the market is a Good Thing™. I am not against the drug’s existence.

In fact, I’m not arguing how efficacious it is. I’m sure it works. If it didn’t, it wouldn’t be approved. I’m merely questioning its place in current treatment paradigms. To explain what I mean, I’m going to use a crude analogy to compare angiotensin II receptor blockers (ARBs) and aliskiren, the only direct renin inhibitor (DRI).

Think of a sink. For whatever reason, you want to keep liquid from going down the drain. Does it make more sense to keep the sink turned off, or to plug the drain directly?

Well obviously if the goal is keeping the drain dry, you’d plug the drain. This is what ARBs do. They prevent specific and non-specific binding at the angiotensin II receptor sites. Tekturna just keeps the sink from turning on and does nothing to block the drain directly. This means there’s still going to be non-specific binding at the angiotensin II receptor site. (Incidentally, this non-specific binding is not merely theoretical; if it were, ACEis would be more effective as a class than the ARBs, but instead they are merely comparable.)

Back to my point: Tekturna is more expensive than the ARBs, and it will be for a long time. I don’t think having aliskiren as an option is a bad thing. I just question how valuable the drug truly is with less expensive ACE inhibitors and ARBs. Sitting here, it doesn’t seem to have a real niche. Would I try Tekturna if nothing else worked? Of course I would. If I were targeting the RAAS, would I reach for it as first-line therapy? Hell no I wouldn’t. I’d go for an ACE inhibitor in most cases.

I’m not going to delve into the heated debates about reactive renin production and other similar topics because I suspect that the reality lies somewhere in the middle ground, as it usually does.

In the meantime, I think don’t think Tekturna has a meaningful place in current drug therapy. If ARBs do not work, it is unlikely that a DRI will, either. The only time I see it perhaps being useful is if a patient cannot tolerate ACEis or ARBs.

[tags]Medicine, pharmacy, Tekturna, aliskiren, hypertension[/tags]

39 thoughts on “I’m still not impressed with Tekturna (aliskiren)

  1. completely agree. I do drug utilization review for one of the state’s medicade programs i saw a general practioner prescribe enalapril, diovan/hctz, and tekturna today. Once i looked up this drug that i had not seen yet for some reason, i was in shock that the MD would make this decision. If the combination of the ACE and the ARB wasn’t enough to set bells off, and that can be useful therapy in some patient, this was 3 alarm. I understand the MOA of each drug, and i’ve looked at comparisons with valsarten alone and in combination and I also don’t believe there is yet a place for this medication. The last thing i looked at said there were no studies with ACEs yet have you run across any? I’m willing to bet we’ll see a lot of hyperk. in the future for these combinations.

  2. I am surprised to read such negative comments. I suffered very unpleasant side effects on ACE and ARB medications which made my life miserable. Tekturna has given me my life back.

  3. These are all interesting comments. JNC 7 states that almost 70% of patients who were taking meds were not “at goal”. All of the aforementioned meds were already on the market and evaluated for this report. I would think that Tekturna would be a welcome addition.

  4. This product has much trial work underway. As per comment above many people with high BP need more than one BP lowering product. This makes Tekturna use appropriate as a 4th or 5th line drug. (There is data to show safety & efficacy in combo). Surrogate marker studies have all proved very positive so far. With referance to the “tap” & drain” analogy and drugs that work on the Renin system no drug completely inhibits the system. Thus the need to a more comprehensive approach.

  5. Interesting comments. As for KP’s comments. There are studies with Tekturna and Ramipril. As for cost, has anyone called the local pharmacies to check, or even the insurance plans? As for outcome studies, we need to wait.

  6. I have recently been taking Tekturna. After I take it, I have nausea, slow uneven heart rate, and a weak pulse for a couple of hours or more. I have some info from the net that these symptoms should be reported to my doctor at once. I went to the doctor, and told her about this, but on that day my heart rate was normal. It had been a couple of hours since I tool the tekturna. She didn’t seem concerned about the problem I’m having daily since my heart rate was normal at the time I visited her. I would like to know if these side effects are common, and how serious they really are. I didn’t take my Tekturna today, and had no side effects. I’m also on Rhythmol SR, 225, but have been taking it without these side effects previous to taking the Tekturna.

  7. It sounds like you have some cardiac rhythm issues. Do you see a Cardiologist? I don’t think Tekturna has any “electric” properties like beta blockers might. It might be worth speaking to a specialist.

  8. I failed on ACEs and ARBs. I have had miserable side effects for the drugs I have taken. I’ve cycles through just about all the classes. I’ve run out of options. Will Tekturna work? Who knows? I’ll let you know in a few weeks. I will say this: There needs to be MORE blood pressure drug choices, not less.

  9. I took Tekturna for about 4 months and had to stop taking the drug for hypertension.
    I experienced the following health problems.
    Vomiting, severe diarrhea, my intestines were inflamed from a esophagus to my Colin. I experience severe stomach and intestinal pains especially in the middle of the night. I lost over 30 pounds because I could not eat food. In my opinion this dangerous drug and should be taken off the market.

  10. I finally stopped Tekturna (see Feb. post). I got a big gut despite being in shape and vigorous workouts. I also washed out on Bystolic a few weeks earlier. I couldn’t take the daily nausea, exhaustion and hair loss. So I’m back to square one, having not been able to tolerate something like 15 drugs or drug combos. I had combined Tekturna with Bystolic because I had run out of drugs and these were newly approved. ARBs make me fat; ACEs give the cough. I’m screwed. I may try another calcium channel blocker but if history is any indication I am going to fail on these, too, due to side effects. Time for serious alternative treatment options, plus C-PAP breathing device.

  11. Rick, of the ACE inhibitor, fosinopril has the lowest incidence of cough. You may want to try it, if you haven’t.

  12. Once you fail on an ACE from cough, that’s it, you’re done. Thanks though.

  13. Once you fail on an ACE from cough, that’s it, you’re done. Thanks though.

    I don’t know who told you that, but they are wrong. People can and do switch ACE inhibitors due to the cough. It doesn’t always work, but it also doesn’t hurt to try.

  14. ACE Inhibitor cough has to do with bradykinin which has to do with cough. Every ACE works the same way. Maybe try an ARB or another RAAS blocker.

  15. No blood pressure medication works well.

    The average person needs 3 blood pressure medications at least if you are going to try for a “normal ” blood pressure of 120/70.

    Blood pressure medications have a lot of side effects.

    Thus having new blood pressure medications, with different mechanisms of action is welcome.

    The increase in Renin with ACEs and ARBs limit their effectiveness. Blocking this system is important since the increase in sympathetic nervous system activity from angiotensin II leads to other problems aside from further increasing blood pressure.

    I am not impressed with ANY blood pressure medication.

    I heartily welcome Tekturna in my tool kit.

  16. I have been taking Tekturna for about 6 months. When I started taking it i was taking 150mg and was doinfg fine then my doctor increased the dosage to 300mg and I am losing my hair terribly, is this the reason? Does Tekturna cause hair loss ???

  17. I have been taking Tekturna for about 6 months. When I started taking it I was taking 150mg and was doing fine then my doctor increased the dosage to 300mg and I am losing my hair terribly, is this the reason? Does Tekturna cause hair loss ???

  18. Tekturna in my area is very affordable. It now has better coverage than MANY of the other ARB’s on the market including Benicar, Cozaar and Micardis. It is preferred on the vast majority of commercial plans at tier 2 status, all major mail-order as well as Med-D plans, and Florida Medicaid w/o prior auth. Tekturna certainly has a purpose and was a needed introduction into this market. Last time I checked there are still ALOT of patients dying on ACE”S and ARBS. This is the ONLY drug that can pharmocologically directly inhibit the culprit thats ailing the body-RENIN. It offers BP reduction without side effect and actually helps reduce side effects of other agents when used in combo therapy. Hypertension is known as the “silent killer” because most times it is asymptomatic. In clinical trials patients on Tekturna felt BETTER than placebo! More patients discontinued treatment with placebo than Tekturna. This is going to be a very important treatment option in Diabetic patients that need BP control b/c of the proteinuria data as well as the studies that have found renal vasodilation far exceeds that seen with ACE’s and ARB’s.

  19. I started using Tekturna about 7 months ago and my hair has gradually been thinning and is now coming out in my comb and brush….. I noticed that Ada Ward had a similiar problem. Has anyone else experienced this???

  20. I’ve been using Tekturna 300 mg for about 1 1/2 years and it works fairly well on BP. However, like Ada and B.P., I started noticing thinning hair 6 months ago and it’s gotten much worse. (I’ve had big hair all my life.) My doc says hair loss isn’t listed as a side effect, not even a rare one…but I wonder if that’s because people don’t report it. Is there a web site or other source where we can find out more?

  21. I have been on Tekturna for about three months.It seems to be managing my blood pressure well enough but my hair has been deteriorating in volume, amount and texture. My hair comes out in copious amounts when I shampoo, brush my hair, or simply run my fingers through my hair. All my life I have had extremely healthy, thick, shiny hair It is now horribly thin, weak and dull. I actually have patches on my scalp where there my hair has noticeably fallen out. It is extremely disturbing. All my doctor can say is, “Tekturna does not cause hair loss.” I will see him in ten days and I will INSIST that Tekturna IS causing my hair loss. If there are others out there besides ESL, Ada Ward, BP and myself who can support the connection of hairloss to Tekturna, please join this discussion. There has to be an alternative to Tekturna for us.

  22. Re: Tekturna hair loss. If everyone who experiences this side effect calls the manufacturer, maybe they will acknowledge and list it. Then the docs will believe us. Side effects are listed post-marketing ONLY if someone reports them. For example, it took years for ACE-inhibitors to have coughing listed – It didn’t show up in their small clinical trials with healthy subjects! Has anyone STOPPED Tekturna and had their hair loss reversed?

  23. I experienced a lot of hair loss after starting Tekturna. I started taking it around August 2009. I slowly started noticing an increase in hairloss but didn’t think it was due to Tekturna. I went from 150mg to 300 and the hairloss increased significantly until I was basically bald in the front. I went back down to 150 and the hairloss has slowed some, but I probably won’t be taking Tekturna anymore.

  24. I have been on Tekturna 75 mg for five months and my hair loss is very noticeable. Prior to this I had a full head of hair.
    Has anyone stopped and had hair regrowth?

  25. I am the same blogger from January 4, 2010. My doctor changed me from Tekturna to a different medication at my request several months ago due to my concerns that this med was causing/contributing to my sudden hair thinning and loss. Remarkably, since that time, I have grown back my hair and it is thick and healthy…… Based on my experience, it does appear that one of the side effects of this medication could be hair thinning and loss….

  26. B.J. – what medication did you doc switch you to that allowed your hair to grow back? Thanks.

  27. My doctor has tried several combinations since January 2010, but I am currently taking Twynsta and my blood pressure so far seems to be under control…. B.J.

  28. Oops, don't know what happened, but I'll start again. I started taking Tekturna about two months ago and experienced a slow thinning of my hair. I didn't pay much attention, but noticed more hair in the sink and in the shower. Then one morning, I brushed out a whole handful of hair and took a look at my scalp. I discovered bald spots all over. I wear my hair up most of the time and had noticed that it was taking more time and creativity to style it. I also have Interstitial cystitis (IC) and was have horrible pain and symptoms dispite my treatment. This was a disorder that had been under control for at least three years. Once I stopped taking the Tekturna (about 2 1/2 weeks ago), the hair loss has definitely lessened. I haven't seen any regrowth yet, but am hopeful. My IC is back to normal and the treatments are working again. I will never take that type of medication again and am not happy that full side-effects are not listed!!!

  29. I recently was switched from Diltiazem to Tekturna. I've been on this new medication for my BP for about a week now and it has not controlled my BP as well as Diltiazem. During the whole week on Tekturna, I regularly took my BP readings. On average it was 150/95 on a good day. In the morning, just as I got up, it was an astonishing 178/100!

    I switched back to Diltiazem and after only 5 hours, my BP is 125/78. I'm not sure why Tekturna is on the market as it does not work and in my estimation, could be dangerous for some people because of the elevated BP.

  30. That info seems to be taken directly from the pharmaceutical company's advertising. I read those same blurbs and was hopefully encouraged that it would work. But it didn't. Although in theory, it sounds good, in real life it fails as what it is supposed to do. If you aren't impressed with “ANY” BP meds, why on earth are you welcoming Tekturna…a blood pressure med? <scratches head=””>

    As you can plainly see from many of the comments here, Tekturan, for whatever reasons, is not a good solution for BP control. Since these are real cases, it makes no sense that you would “heartily welcome” Tekturna. Of course, if you work for the company that makes it, then everything makes sense.</scratches>

  31. My Dr. told me I was beautiful in spite of my hair thinning. I have been on this med for about 16 months. First on the 150mg and than on 300mg. Recently I went back to the 150mg with no change in blood pressure. Before that, I was on Coreg which caused hair loss too. I was told hair loss happens in only rare cases due to blood pressure pills. I going to ask for a change and find out for myself. I'm glad you got your hair back.

  32. I was on 150mg of Tekturna which didn’t work. My dr changed it to 300mg. That’s when I noticed when brushing my hair lots and lots of hair was coming out. I had finally found a hairstyle I liked for my thin hair and then after Tekturna my hair is unsuitable for any hairstyle and I have started wearing wigs while I treat my hair with an Indian remedy for hair loss. Oops, almost forgot, I got a cough too. Stopped taking the stuff and now I’m doing deep breathing to try and control my blood pressure – also will lose weight. This stuff is junk.

  33. My doctor started me on Tekturna last month, giving me some sample bottles. The first day it lowered my pressure significantly. The next day it appeared to have no effect at all, and pretty much continued that way. A few days ago he wrote me a prescription for Tekturna and when I went to fill it I was told it would cost me $83 for a one month’s supply, and that was AFTER what my insurance would pay. I told them to forget it, and I’m going to ask my doctor if there is something else I can take, besides the Metoprolol and Losartan I’m already on.

  34. I have IC too, and am an Ovarian Cancer patient … 5 years and counting.  Curious … what kind of treatment are you doing for your IC.  I have been doing nothing but watching the best I can for foods, etc, that irritate it having said no to Elmiron several years ago.  As far as Tektuna, my Doc just gave some samples today as I am losing too much protein in urine and tying to get my hypertension under control.  My cancer drug is Avastin and is responsible for both hypertension and kidney damage.      Thanks, Mary

  35. i also have had a lot of hair loss while on tekturna, I think the dr:s get a kick back for pushing pills,I,d like
    to see them take the pills they prescribe! I have been seeing my dr: for high blood pressure for over a yr: now,he has not listened to my heart with a stethiscope yet—-guess it,s time to change dr:s—-

  36. FYI: an independent Data
    Monitoring Committee (DMC) overseeing the clinical trial became alarmed at the
    high rate of Tekturna health risks among tests subjects and recommended
    Novartis pull the plug.

    The company has not yet released data from the study,
    but has told all of the clinical trial’s investigators to remove Tekturna
    products from their patients’ treatment regimen.


    I reported the above to my Cardio Dr and he took me off the drug. been on it for 11 mo.

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