Generic Name and Formulations:
Sacubitril, valsartan; 24mg/26mg, 49mg/51mg, 97mg/103mg; tabs.
Novartis Pharmaceuticals Corp
Indications for ENTRESTO:
To reduce risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II–IV) and reduced ejection fraction; usually given with other therapies, in place of an ACEI or other ARB.
Initially 49mg/51mg twice daily; double the dose after 2–4 weeks to target maintenance dose of 97mg/103mg twice daily as tolerated. Not currently on ACEI/ARB, previously on low doses of ACEI/ARB, severe renal impairment (eGFR <30mL/min/1.73m2), or moderate hepatic impairment (Child-Pugh B): initially 24mg/26mg twice daily; double the dose every 2–4 weeks to target maintenance dose of 97mg/103mg twice daily as tolerated. If switching from or to an ACEI: allow 36 hour wash-out period between taking the two drugs.
History of angioedema related to previous ACE inhibitor or ARB therapy. Concomitant ACE inhibitors. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Discontinue if angioedema occurs; do not re-administer. Give SC epinephrine for airway obstruction if indicated. Black patients may have higher risk of angioedema than non-Black patients. Avoid in hereditary angioedema. May cause symptomatic hypotension. Correct salt/volume depletion prior to initiation or start at a lower dose. Adjust concomitant diuretic or antihypertensive doses if hypotension occurs. Reduce dose or temporarily discontinue if hypotension persists. Monitor renal function in renal artery stenosis, severe CHF. Monitor serum creatinine and down-titrate or interrupt dose if significant renal dysfunction develops. Monitor for hyperkalemia esp. in severe renal impairment, diabetes, hypoaldosteronism, or high K+ diet. Severe hepatic impairment: not recommended. Neonates. Pregnancy (2nd & 3rd trimesters); consider alternative therapy. Nursing mothers: not recommended.
See Contraindications. Dual inhibition of the renin-angiotensin system: avoid concomitant with an ARB. Concomitant aliskiren in renal impairment (eGFR <60mL/min/1.73m2); avoid. Concomitant K+ supplements, K+ -sparing diuretics, K+ -containing salt substitutes may cause hyperkalemia. Worsening renal function and possible acute renal failure with NSAIDs, including selective COX-2 inhibitors (monitor renal function periodically in elderly and/or volume depleted). May increase lithium levels; monitor. May inhibit OATP1B1 and OATP1B3 transporters.
Neprilysin inhibitor + angiotensin II receptor blocker.
Hypotension, hyperkalemia, cough, dizziness, renal failure, increased serum creatinine, decreased hemoglobin/hematocrit.
Endocrinology Advisor Articles
- Single Blood Sample Highly Predictive for Subsequent Diabetes Diagnosis
- Adjunctive Metformin for Insulin Resistance in T1D: A Clinical Perspective
- Effect of Fructose, Allulose on Postprandial Glucose Regulation in Type 2 Diabetes
- Sex Hormone Levels May Affect Postmenopausal Heart Disease Risk
- Menopausal Hormone Therapy Slows Cognitive Decline in Postmenopausal Women
- Diabetes Treatments
- Metformin May Decrease Colorectal Cancer Risk Among Males With Diabetes
- SGLT2 Inhibitor, GLP-1 Receptor Agonist Combination Treatment for Type 2 Diabetes: Expert Insights
- Semaglutide May Induce Weight Loss in Type 2 Diabetes Despite BMI
- FDA Clears Omnipod DASH System for Diabetes Management
- Effect of Infant Feeding Practices and Gut Microbiota on Overweight in First Year
- Empagliflozin, Linagliptin Combination Therapy vs Linagliptin Monotherapy for Type 2 Diabetes
- Cleared Blood Glucose Monitor Systems Not Always Accurate
- CDC: Obesity Prevalence Higher in Non-Metropolitan Counties
- Vascular Mortality Declining in Adults With Diabetes in the United States