Indications
Sacubitril is used together with Valsartan, as a combined tablet, to treat long-term (chronic) heart failure in adults whose heart pumps weakly (reduced ejection fraction). It lowers the risk of hospital admission and death from heart failure. It is not used on its own.
How It Works
Sacubitril blocks an enzyme called neprilysin. This raises natural substances in the body that widen blood vessels and help the kidneys remove extra salt and water. Valsartan blocks the effect of angiotensin II, a hormone that narrows blood vessels. Together they reduce the strain on the heart.
Dosage and Administration
The dose is set and adjusted by the doctor. Adults usually start with 49 mg/51 mg (sacubitril/valsartan) twice a day, or 24 mg/26 mg twice a day for people with low blood pressure, kidney or liver problems, or who have not taken an ACE inhibitor or angiotensin receptor blocker before. The dose is usually doubled every 2 to 4 weeks, as tolerated, up to 97 mg/103 mg twice a day. Take with or without food. Do not stop taking it without speaking to your doctor.
Interactions
- ACE inhibitors (such as Enalapril or Ramipril): must not be taken together; stop the ACE inhibitor at least 36 hours before starting, because of the risk of severe swelling (angioedema).
- Other angiotensin receptor blockers (such as Losartan): do not combine, since this tablet already contains Valsartan.
- Aliskiren: avoid, especially in diabetes or kidney disease.
- Potassium supplements, salt substitutes containing potassium, Spironolactone, Eplerenone and other potassium-sparing diuretics: can raise blood potassium.
- Painkillers such as Ibuprofen and other NSAIDs: can affect kidney function.
- Lithium: levels may rise.
- It can raise blood levels of some statins, such as Atorvastatin.
Contraindications
- Allergy to sacubitril, valsartan or any ingredient.
- Taking an ACE inhibitor now or within the last 36 hours.
- A past history of angioedema (sudden swelling of the face, lips, tongue or throat), whatever the cause.
- Use with Aliskiren in people with diabetes or moderate to severe kidney impairment.
- Severe liver disease, including biliary cirrhosis.
- Pregnancy, particularly the second and third trimesters.
Side Effects
Common side effects include low blood pressure (dizziness, lightheadedness, especially on standing), high blood potassium, reduced kidney function, cough, tiredness and headache. Get urgent medical help if you have swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing (angioedema); fainting; a very slow or irregular heartbeat; or passing much less urine than usual.
Pregnancy and Lactation
Do not use during pregnancy, as it can harm or kill the unborn baby. Women who could become pregnant should use reliable contraception and tell their doctor at once if they become pregnant. Breastfeeding is not recommended while taking it.
Precautions and Warnings
Your doctor will check blood pressure, kidney function and potassium levels before and during treatment. Tell your doctor if you have kidney or liver disease, narrowing of the kidney arteries, dehydration or a history of angioedema. Get up slowly from sitting or lying to avoid dizziness. Do not drive or use machines if you feel dizzy or tired. People of Black African origin may have a higher risk of angioedema.
Overdose
An overdose is most likely to cause very low blood pressure, with dizziness or fainting. Lie down with the legs raised and seek emergency medical help.
Therapeutic Class
Angiotensin receptor neprilysin inhibitor (ARNI); heart failure medicine.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Keep in the original pack to protect from moisture.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.