Jeraygo (Aprocitentan)

• Jeraygo, an endothelin receptor antagonist, is used in the management of resistant hypertension.
• Resistant hypertension: lowers blood pressure in patients whose hypertension is uncontrolled by standard therapy.

• Aprocitentan selectively antagonizes both endothelin‑A (ETA) and endothelin‑B (ETB) receptors on vascular smooth‑muscle cells. By blocking these receptors, it prevents endothelin‑1–mediated vasoconstriction, promotes vasodilation, and reduces peripheral vascular resistance, resulting in a decrease in systemic arterial blood pressure.

Aprocitentan may cause a range of adverse reactions, which are categorized by frequency.

Common Side Effects

• Headache: mild to moderate pain often reported during early treatment.
• Dizziness: sensation of light‑headedness, especially when standing quickly.
• Peripheral edema: swelling of the ankles or lower legs.
• Nasal congestion: stuffy or runny nose.
• Fatigue: feeling unusually tired or weak.
• Nausea: mild stomach discomfort.

Serious or Rare Side Effects

• Elevated liver enzymes: may indicate hepatic injury.
• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Anemia: reduction in red blood cell count.
• Pulmonary edema: fluid accumulation in the lungs.
• Heart failure exacerbation: worsening of cardiac function.
• Severe allergic reactions: rash, swelling, or difficulty breathing.

• Before initiating therapy with Jeraygo, several safety considerations should be observed.
• Monitor blood pressure: ensure adequate control and avoid excessive hypotension.
• Assess liver function: perform baseline and periodic liver enzyme tests.
• Evaluate for edema: watch for signs of fluid retention, especially in the lower extremities.
• Review concomitant medications: consider interactions with other antihypertensives and hepatotoxic drugs.
• Avoid in severe hepatic impairment: contraindicated in patients with marked liver dysfunction.
• Store at room temperature: keep in the original pack, protect from moisture and direct sunlight.

Aprocitentan can interact with several drug classes, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase Aprocitentan exposure.
• Strong CYP3A4 inducers (e.g., rifampin): may reduce therapeutic effect.
• Other endothelin receptor antagonists: additive vasodilatory effects.
• Potent diuretics: heightened risk of hypotension.
• NSAIDs: increased potential for renal impairment.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may enhance blood‑pressure lowering.
• Lithium: possible increase in lithium levels.
• Warfarin: potential alteration of anticoagulant effect.
• Calcium channel blockers: monitor for additive hypotensive response.
• Antidiabetic agents: watch for changes in glucose control.