Entresto (Sacubitril/Valsartan)
Matt Kauflin, Pharm.D., BCPS

Sacubitril/Valsartan – Entresto®

Drug Class – Angiotensin II Receptor Antagonist/Neprilysin Inhibitor (ARNI)

Mechanism of Action – Valsartan is a competitive antagonist of the angiotensin II receptor which is responsible for the effects of angiotensin II.  Sacubitril is a prodrug that inhibits neprilysin.  Neprilysin is enzyme responsible for the metabolism of natriuretic peptides

Dosage Forms – Oral tablet (Sacubitril/Valsartan) 24 mg/26 mg, 49 mg/51 mg, 97 mg/103 mg

Dosing – Patients on a low dose of ACEI/ARB or not previously on an ACEI/ARB start at 24 mg/26 mg po BID.  Patients already on moderate or high dose of ACEI/ARB can start at 40 mg/51 mg po BID.  You can titrate every 2 to 4 weeks as tolerated

Indications

  1. 1.Heart failure with reduced ejection (HFrEF) 

 

Sacubitril/Valsartan – Entresto®

Dosage adjustment

  • •Dosage adjustment is required in hepatic impairment 

  • •Dosage adjustment is required in renal impairment 

Contraindications

  • •Hypersensitivity to any component 

  • •History of angioedema  

  • •Concomitant use with ACEIs 

  • •Concomitant use with aliskiren 

Warnings

  • •Pregnancy 

Pregnancy

  • •Contraindicated in pregnancy 

  • •Avoid use in breastfeeding 

 

Sacubitril/Valsartan – Entresto®

Drug Interactions

  • •ACEIs/Aliskiren 

  • •NSAIDs 

  • •Diuretics 

  • •Potassium supplements 

Adverse Effects

  • •Adverse reactions occurring ≥ 5% are hypotension, hyperkalemia, cough, dizziness, and renal failure 

Monitoring Parameters

  • •S/S of heart failure – ability to perform ADL 

  • •BP, renal function, potassium, weight 

Therapeutic Pearls

  • •BNP vs. NT-pro-BNP 

  • •When switching from an ACEI, sacubitril/valsartan is started at least 36 hours after the last dose of ACEI 

 

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