STEPS

New Drug Reviews

Sacubitril/Valsartan (Entresto) for Heart Failure

 

Am Fam Physician. 2016 Oct 15;94(8):611-612.

Sacubitril/valsartan (Entresto) is a combination of a neprilysin inhibitor and an angiotensin receptor blocker (ARB). It is labeled for use to reduce the risk of cardiovascular death and the rate of hospitalization in patients with chronic heart failure (New York Heart Association [NYHA] class II to IV) and reduced ejection fraction.1

View/Print Table

DrugDosageDose formCost*

Sacubitril/valsartan (Entresto)

49/51 mg twice daily to start, increasing to 97/103 mg twice daily after two to four weeks if tolerated

24/26-, 49/51-, and 97/103-mg tablets

$413


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed August 3, 2016).

DrugDosageDose formCost*

Sacubitril/valsartan (Entresto)

49/51 mg twice daily to start, increasing to 97/103 mg twice daily after two to four weeks if tolerated

24/26-, 49/51-, and 97/103-mg tablets

$413


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed August 3, 2016).

SAFETY

The most significant adverse effects of sacubitril/valsartan are symptomatic hypotension, renal dysfunction, and hyperkalemia. Clinically relevant hypotension will occur in about 18% of patients taking sacubitril/valsartan vs. 12% of those taking enalapril (Vasotec; number needed to treat to harm = 17). Approximately 3% of patients will develop an elevated creatinine level (greater than 2.5 mg per dL [221 μmol per L]), compared with 4.5% of patients receiving enalapril. Hyperkalemia (serum potassium concentration greater than 5.5 mEq per L [5.5 mmol per L]) will occur in approximately 16% of patients, a rate similar to that of enalapril,1,2 and it is more likely in patients treated with other potassium-sparing diuretics. Angioedema occurs infrequently and at about the same rate as in patients treated with angiotensin-converting enzyme (ACE) inhibitors. Sacubitril/valsartan should not be used in patients with a history of angioedema related to previous ACE inhibitor or ARB therapy. Sacubitril/valsartan can cause fetal harm when administered to pregnant women and should not be used in patients who are breastfeeding.

TOLERABILITY

Sacubitril/valsartan is generally well tolerated by most patients. Approximately 11% of patients will discontinue therapy because of adverse effects.1,2 It should not be used t

Address correspondence to Judy Cheng, PharmD, MPH, FCCP, BCPS, at judy.cheng@mcphs.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

1. U.S. National Library of Medicine. DailyMed. Drug label information: Entresto—sacubitril and valsartan tablet, film coated. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=000dc81d-ab91-450c-8eae-8eb74e72296f. Accessed May 9, 2016.

2. McMurray JJ, Packer M, Desai AS, et al.; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993–1004.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Contributing Editor.

A collection of STEPS published in AFP is available at http://www.aafp.org/afp/steps.


 

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