From the Guidelines
Valsartan is recommended for anuric patients with cardiomyopathy, as it can help reduce cardiac workload and promote reverse remodeling, with careful monitoring of potassium levels and renal function, as supported by the most recent study 1. The use of valsartan in anuric patients requires careful consideration of the potential risks and benefits.
- Key benefits of valsartan include:
- Reducing afterload and decreasing ventricular filling pressures
- Inhibiting harmful cardiac remodeling processes
- Improving cardiac output and ejection fraction
- Reducing symptoms like dyspnea and fatigue
- Key risks and considerations include:
- Hyperkalemia risk due to impaired potassium excretion
- Altered drug clearance due to lack of kidney function
- Need for cautious dosing and frequent monitoring
- Potential for hypotension According to the study 1, sacubitril/valsartan has demonstrated superiority over angiotensin-converting enzyme inhibitors or angiotensin receptor blocker treatment with respect to clinical outcomes and LV reverse remodeling in patients with HFrEF.
- The study 1 also supports the use of valsartan/sacubitril in replacement of ACE inhibitor or ARB therapy to reduce mortality and morbidity. In terms of dosing, valsartan is typically started at a lower dose of 40mg daily and carefully titrated up to 160mg daily as tolerated, with close monitoring of potassium levels and renal function 1.
- Regular laboratory monitoring (every 1-2 weeks initially) is essential, and the medication should be temporarily held if potassium exceeds 5.5 mEq/L or if hypotension occurs. Overall, the use of valsartan in anuric patients with cardiomyopathy requires careful consideration of the potential risks and benefits, as well as close monitoring and cautious dosing.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Valsartan and Cardiomyopathy in Anuric Patients
- Valsartan, an angiotensin receptor blocker, is often used in combination with sacubitril, a neprilysin inhibitor, to treat heart failure with reduced ejection fraction 2.
- The use of sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalizations due to heart failure in adult patients with reduced ejection fraction when compared to enalapril 2.
- In patients with anthracycline-induced cardiomyopathy, sacubitril/valsartan has been used with success, demonstrating some recovery of function and normalization of N-terminal pro B-type natriuretic peptide levels 2.
Mechanism of Action
- The combination of sacubitril and valsartan increases the levels of several vasoactive peptides, including atrial natriuretic peptide (ANP), which may mediate the beneficial effects of sacubitril/valsartan 3.
- ANP has been shown to increase significantly after initiation of sacubitril/valsartan, with a larger early increase in ANP associated with larger later improvements in left ventricular ejection fraction and left atrial volume index 3.
Monitoring and Management
- Close monitoring of serum potassium and renal function is recommended during the management of heart failure, particularly in patients with reduced ejection fraction 4.
- The "5B" approach, which includes balance of fluids, blood pressure, biomarkers, bioimpedance vector analysis, and blood volume, may be useful in managing fluid overload and congestion in heart failure patients 5.
- However, the use of furosemide in anuric patients has been shown to have no significant effects on central cardiac haemodynamics, and its use in these patients is not supported by current evidence 6.