Can Entresto (sacubitril/valsartan) be discontinued?

From the Guidelines

I strongly advise against stopping Entresto (sacubitril/valsartan) without consulting your healthcare provider first, as it is a crucial medication for managing heart failure and reducing the risk of hospitalization and death 1. Entresto is a prescription medication that works by improving heart function and reducing strain on the cardiovascular system. Abruptly discontinuing it can lead to worsening heart failure symptoms or potentially dangerous cardiovascular consequences.

Importance of Consistent Treatment

The 2022 AHA/ACC/HFSA guideline for the management of heart failure emphasizes the importance of consistent treatment with medications like Entresto, which has been shown to reduce the risk of cardiovascular death or heart failure hospitalization by 20% 1. The guideline recommends that patients with heart failure with reduced ejection fraction (HFrEF) receive optimal treatment with an ACE inhibitor, a beta-blocker, and an MRA, and that sacubitril/valsartan be used as a replacement for an ACE inhibitor to further reduce the risk of HF hospitalization and death.

Risks of Discontinuation

Discontinuing Entresto without consulting a healthcare provider can lead to a range of negative consequences, including worsening heart failure symptoms, increased risk of hospitalization, and potentially life-threatening cardiovascular events. A recent analysis of real-world data found that discontinuation rates for sacubitril/valsartan were as high as 27%, and that patients who discontinued treatment had a greater risk of death or hospitalization for HF compared with patients who continued treatment 1.

Alternative Solutions

If you are experiencing side effects or concerns about taking Entresto, it is essential to discuss these with your healthcare provider rather than stopping the medication on your own. Your doctor may need to adjust your dose, temporarily pause the medication, or switch you to an alternative treatment depending on your specific situation. Additionally, if you are considering stopping Entresto due to cost concerns, discuss this with your healthcare provider as there may be assistance programs available.

Key Takeaways

• Do not stop taking Entresto without consulting your healthcare provider first.
• Entresto is a crucial medication for managing heart failure and reducing the risk of hospitalization and death.
• Discontinuing Entresto without consulting a healthcare provider can lead to negative consequences, including worsening heart failure symptoms and increased risk of cardiovascular events.
• If you are experiencing side effects or concerns, discuss these with your healthcare provider to determine the best course of action.

From the FDA Drug Label

If hypotension occurs, consider dose adjustment of diuretics, concomitant antihypertensive drugs, and treatment of other causes of hypotension (e.g., hypovolemia). If hypotension persists despite such measures, reduce the dosage or temporarily discontinue sacubitril and valsartan. Permanent discontinuation of therapy is usually not required.

Stopping Entresto (sacubitril and valsartan) can be considered in certain situations, such as:

• If angioedema occurs, discontinue sacubitril and valsartan immediately.
• If hypotension persists despite measures to manage it, temporary discontinuation may be necessary.
• In cases of impaired renal function, down-titration or interruption of sacubitril and valsartan may be required. However, permanent discontinuation of therapy is usually not required 2.

From the Research

Stopping Entresto

• Stopping Entresto (sacubitril/valsartan) may lead to deterioration of left ventricular ejection fraction (LVEF) and worsening of the functional class in patients with heart failure with reduced ejection fraction (HFrEF) 3
• Discontinuation of sacubitril/valsartan in patients with HFrEF can result in worsening of New York Heart Association (NYHA) class, LVEF, and end-diastolic volume (EDV) compared to continued treatment with sacubitril/valsartan 3
• Switching from sacubitril/valsartan to angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) may not provide the same benefits as continued treatment with sacubitril/valsartan 3, 4, 5

Comparison to Other Treatments

• Sacubitril/valsartan has been shown to be superior to ACEI or ARB in reducing heart failure hospitalizations, cardiovascular mortality, and all-cause mortality in patients with HFrEF 4, 5
• However, when compared to equivalent doses of ARB/ACEI, sacubitril/valsartan is not superior in reducing mortality and worsening heart failure 5
• Sacubitril/valsartan may be considered as a first-line therapy in outpatient or in-hospital HFrEF patients, and possibly also in HFmrEF patients 6