Sacubitril and Valsartan

Angiotensin-II Antagonist · Angiotensin II antagonist/Neprilysin inhibitor

Indications

Symptomatic chronic heart failure with decreased ejection fraction.

Dosage

In patients not currently taking an ACE inhibitor or angiotensin II receptor antagonist, or stabilized on low doses of either of these agents: Initially 26/24 mg twice daily for 3-4 wks, increased if tolerated to 51/49 mg twice daily for 3-4 wks, then increased if tolerated to 103/97 mg twice daily. In patients currently stabilized on an ACE inhibitor or angiotensin II receptor antagonist: Initially 51/49 mg twice daily for 2-4 wks, increased if tolerated to 103/97 mg twice daily, consider a starting dose of 26/24 mg if systolic BP <110 mmHg.

Adverse Effects

Anaemia, gastritis, diarrhoea, nausea, vertigo, hypoglycaemia, hypokalaemia.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Concomitant use of ACE inhibitor, systolic BP <100 mmHg.

Interactions

ACE inhibitors (avoid), ciprofloxacin, cyclosporine, amifostine, atypical second generation antipsychotic agents, drospirenone, duloxetine, hydrochlorothiazide, levodopa, nitroprusside, NSAIDs, pholcodine, blood pressure lowering agents, potassium-sparing diuretics, low molecular weight heparins, methylphenidate, amphetamines, pentoxifylline, nicorandil, dapoxetine, PDE 5 inhibitors, potassium salts.

Advice to Patient

Take with or without meals.

Pharmacokinetics

SACUBITRIL: Metabolism: Metabolized by esterases. Bioavailability: >60%. Half-life elimination: 1.4 hrs. Time to peak: 0.5 hrs. Excretion: Urine (52%-68%). Faeces (37%-48%). VALSARTAN: Metabolism: Minimally metabolized. Half-life elimination: 9.9 hrs. Time to peak: 1.5 hrs. Excretion: Urine (approx. 13%). Faeces (86%).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.