Sacubitril + Valsartan: Uses, Dosage, Side Effects & Brands | MedexInfo

Sacubitril + Valsartan

Generic NameSacubitril / Valsartan

Therapeutic ClassAngiotensin receptor-neprilysin inhibitor (ARNI)

Max / 24h97/103 mg BID (maximum standard dose)

Common Dose49/51 mg orally twice daily, may titrate to 97/103 mg BID

PregnancyContraindicated (Category D)

Indications ▼

Treatment of heart failure with reduced ejection fraction (HFrEF)

Reduces risk of cardiovascular death and hospitalization in HFrEF patients

Mechanism & Pharmacokinetics ▼

Mechanism: Sacubitril inhibits neprilysin, increasing levels of natriuretic peptides, leading to vasodilation, natriuresis, and inhibition of fibrosis; Valsartan blocks angiotensin II receptor (AT1), reducing vasoconstriction and aldosterone secretion.

Pharmacokinetics: Oral absorption of both components; peak plasma levels 1–2 hours post-dose; primarily excreted via urine and feces; half-life approximately 11 hours (Sacubitril metabolite) and 9–11 hours (Valsartan).

Dosage & Administration ▼

Condition	Recommended Dose	Frequency
HFrEF (patients not previously on ACEi/ARB)	24/26 mg	Orally twice daily, titrate every 2–4 weeks
HFrEF (patients previously on ACEi/ARB)	49/51 mg	Orally twice daily, titrate to 97/103 mg BID as tolerated

Note: Allow at least 36 hours between last ACE inhibitor dose and initiation; monitor blood pressure, renal function, and potassium.

Side Effects ▼

Hypotension, dizziness

Hyperkalemia

Renal impairment

Cough (less common than ACEi)

Rare: Angioedema

Contraindications ▼

History of angioedema related to ACEi or ARB

Pregnancy (Category D)

Severe hepatic impairment

Concomitant ACE inhibitor use (risk of angioedema)

Drug Interaction ▼

ACE inhibitors: increased risk of angioedema

Potassium-sparing diuretics or supplements: risk of hyperkalemia

NSAIDs: risk of renal impairment

Pregnancy & Lactation ▼

Contraindicated in pregnancy (Category D)

Excretion in breast milk unknown; avoid use

Clinical / Research Summary ▼

Therapeutic Role: Reduces mortality and hospitalization in patients with HFrEF; combines neprilysin inhibition with angiotensin receptor blockade.

Clinical Effectiveness: Demonstrated in PARADIGM-HF trial: superior to enalapril in reducing risk of cardiovascular death or HF hospitalization.

Safety Profile: Well tolerated; monitor BP, renal function, and potassium closely during therapy.

Current Research: Focus on use in HFpEF, combination with SGLT2 inhibitors, and long-term cardiovascular outcomes.

Patient Counseling Points ▼

Monitor blood pressure and report dizziness or fainting

Avoid potassium supplements unless prescribed

Do not take ACE inhibitors concurrently

Report swelling of face, lips, tongue, or throat (angioedema)

Adhere strictly to prescribed titration schedule

Storage & Handling ▼

Store at 20–25°C, protect from moisture and light

Keep out of reach of children