Bismillah, alhamdulillah:

Personally I never like combined preparations, while convenient for patients and seeming to offer the benefit of better patient compliance – I am always worried about unpredicted consequences for my patients and the difficulty with which I came lay the blame for a side effect on a specific medication. Here is another example of a new agent being combined with an old agent causing trouble albeit in a specific population set but I think the general principle holds true.

“The label changes are based on preliminary data from a Novartis-sponsored clinical trial called Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), which evaluated aliskiren in combination with ACE inhibitors and ARBs. A higher risk for renal impairment, hypotension, and hyperkalemia, along with an apparent lack of efficacy, caused Novartis to halt the trial in December 2011.”


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