From the Guidelines
Entresto sprinkle formulation would be prescribed instead of regular tablets for patients who have difficulty swallowing pills, such as young children, elderly patients with dysphagia, or those with feeding tubes. The sprinkle version contains the same active ingredients (sacubitril/valsartan) as the standard tablets but comes in oral pellets that can be opened and sprinkled onto soft foods like applesauce or mixed with a small amount of liquid. This alternative formulation ensures that patients who cannot take traditional tablets can still receive this important heart failure medication without compromising its effectiveness. The dosing remains similar to the tablet form, with adjustments made based on the patient's weight, kidney function, and clinical response 1. The sprinkle formulation maintains the same pharmacological benefits of Entresto - reducing heart failure hospitalizations and mortality by simultaneously inhibiting neprilysin (sacubitril) and blocking angiotensin II receptors (valsartan), thereby improving cardiac function and reducing strain on the heart. Key considerations for prescribing Entresto sprinkle formulation include:
- Patient's ability to swallow tablets
- Presence of dysphagia or feeding tubes
- Weight and kidney function for dosing adjustments
- Clinical response to the medication According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure, sacubitril/valsartan is recommended for patients with HFrEF who remain symptomatic despite treatment with ACE inhibitors, beta-blockers, and MRAs 1. However, the guideline does not specifically address the use of the sprinkle formulation, but it can be inferred that the sprinkle formulation would be a suitable alternative for patients who have difficulty swallowing the traditional tablet form. It is essential to note that the use of Entresto sprinkle formulation should be guided by the patient's individual needs and medical history, and healthcare providers should consult the latest clinical guidelines and evidence-based recommendations when making treatment decisions 1.
From the FDA Drug Label
If you or your child cannot swallow tablets, or if tablets are not available in the prescribed strength, you or your child may take Sacubitril and Valsartan tablets prepared as a liquid (oral) suspension
A patient may be prescribed Entresto sprinkle instead of the regular formulation if they cannot swallow tablets or if tablets are not available in the prescribed strength 2. This is because the sprinkle formulation can be prepared as a liquid (oral) suspension, making it easier to administer to patients who have difficulty swallowing tablets. Key considerations for using the sprinkle formulation include:
- The patient's inability to swallow tablets
- The availability of tablets in the prescribed strength It is essential to follow the doctor's instructions for taking Sacubitril and Valsartan Tablets, including any adjustments to the dose when switching between the tablet and liquid suspension formulations 2.
From the Research
Entresto Sprinkle vs Regular Formulation
The decision to prescribe Entresto (sacubitril/valsartan) sprinkle instead of the regular formulation may depend on several factors, including patient-specific needs and preferences. Some possible reasons for prescribing the sprinkle formulation include:
- Difficulty swallowing tablets or capsules, as the sprinkle formulation can be easily mixed with food or water 3
- Need for more flexible dosing, as the sprinkle formulation can be easily divided or mixed with food to achieve the desired dose
- Presence of certain medical conditions, such as dysphagia or gastrointestinal disorders, that may require a different formulation
Clinical Benefits of Entresto
Entresto has been shown to have several clinical benefits, including:
- Reduced mortality and hospitalization due to heart failure 4, 5
- Improved symptoms and quality of life for patients with heart failure 4, 6
- Reduced risk of ventricular arrhythmias and sudden cardiac death 6
- Improved left ventricular ejection fraction and reduced myocardial remodeling 5, 7
Patient-Specific Factors
The choice between Entresto sprinkle and regular formulation may also depend on patient-specific factors, such as:
- Age and comorbidities, as older patients or those with certain medical conditions may require a different formulation
- Renal function, as Entresto may need to be dose-adjusted in patients with renal impairment
- Concomitant medications, as Entresto may interact with certain medications and require dose adjustments or monitoring 3, 5