Entresto

Reduce risk of CV death & hospitalization for heart failure in adults w/ chronic heart failure, most clearly evident in patients w/ left ventricular ejection fraction below normal.

Initially 100 mg bid, doubled at 2-4 wk up to 200 mg bid as tolerated. Patient not currently taking ACE inhibitor or ARB or taking low doses of these medicinal products Initially 50 mg bid & slow dose titration (doubling every 3-4 wk). Patient w/ systolic BP ≥100-110 mmHg Initially 50 mg bid. Moderate (eGFR 30-60 mL/min/1.73 m²), severe renal impairment (eGFR <30 mL/min/1.73 m²), moderate hepatic impairment (Child-Pugh B classification) or patient w/ AST/ALT values >2x ULN range Initially 50 mg bid.

May be taken with or without food.

Hypersensitivity. Concomitant use w/ ACE inhibitors; do not administer until 36 hr after discontinuing. History of angioedema related to previous ACE inhibitor or ARB therapy. Hereditary or idiopathic angioedema. Concomitant use w/ aliskiren-containing medicinal products in patients w/ DM or renal impairment (eGFR <60 mL/min/1.73 m²). Severe hepatic impairment, biliary cirrhosis & cholestasis. Pregnancy (2nd & 3rd trimester).

Dual blockade of renin-angiotensin-aldosterone system (RAAS). Not recommended in combination w/ direct renin inhibitors (eg, aliskiren); ARB-containing product. Routinely monitor BP when initiating therapy or during dose titration. Temporary down-titration or discontinue if hypotension occurs. Correct Na- &/or vol-depletion before starting treatment. Not to be initiated in patients w/ serum K level >5.4 mmol/L. Monitor serum K in patients w/ risk factors eg, renal impairment, DM, hypoaldosteronism, receiving high K diet or on mineralocorticoid antagonists. Discontinue treatment immediately if angioedema occurs. Black patients. Patients w/ bilateral or unilateral renal artery stenosis; monitor renal function. NYHA functional class IV. Not suitable w/ B-type natriuretic peptide as biomarker of heart failure. Psychiatric events eg, hallucinations, paranoia & sleep disorders, in context of psychotic events; discontinuation of treatment should be considered. Renal impairment. Increased risk of decreased renal function by dehydration or concomitant use of NSAIDs. Not recommended in patients w/ ESRD. Moderate hepatic impairment (Child-Pugh B classification) or w/ AST/ALT values >2x ULN range. May influence the ability to drive & use machines. Not recommended during pregnancy (1st trimester) & lactation. Childn <18 yr.

Hyperkalemia; hypotension; renal impairment. Anemia; hypokalemia, hypoglycemia; dizziness, headache, syncope; vertigo; orthostatic hypotension; cough; diarrhea, nausea, gastritis; renal failure; fatigue, asthenia.

Increased risk of angioedema w/ ACE inhibitors. Higher frequency of adverse events eg, hypotension, hyperkalemia & decreased renal function including acute renal failure w/ aliskiren. Not recommended w/ ARB-containing product. Increase systemic exposure of OATP1B1 & OATP1B3 substrates eg, statins. Greater BP reduction w/ PDE5 inhibitors (eg, sildenafil). Increased serum K & creatinine w/ K-sparing diuretics (eg. triamterene, amiloride), mineralocorticoid antagonists (eg, spironolactone, eplerenone), K supplements, salt substitutes containing K or other agents (eg, heparin). Increased risk of worsening renal function w/ NSAIDs including selective COX-2 inhibitors. Reversible increases in serum lithium conc & toxicity. Reduced C_max & AUC of furosemide & metformin. Nitrates eg, nitroglycerine. May increase systemic exposures w/ inhibitors of OATP1B1, OATP1B3, OAT3 (eg, rifampicin, ciclosporin), OAT1 (eg, tenofovir, cidofovir) or MRP2 (eg, ritonavir).

Other Cardiovascular Drugs

C09DX04 - valsartan and sacubitril ; Belongs to the class of angiotensin II receptor blockers (ARBs), other combinations. Used in the treatment of cardiovascular disease.

Rx