From the FDA Drug Label
In adults and pediatric patients with severe renal impairment estimated glomerular filtration rate (eGFR less than 30 mL/min/1.73 m2), start sacubitril and valsartan tablets at half the usually recommended starting dose. No starting dose adjustment is needed for mild or moderate renal impairment.
The recommended dose of Entresto (sacubitril/valsartan) in patients with impaired renal function is as follows:
- Severe renal impairment (eGFR < 30 mL/min/1.73 m2): Start at half the usually recommended starting dose.
- Mild or moderate renal impairment: No starting dose adjustment is needed. 1
From the Research
For patients with impaired renal function, Entresto (sacubitril/valsartan) dosing should be adjusted based on the severity of renal impairment, with a lower starting dose of 24/26 mg twice daily recommended for those with severe renal impairment (eGFR <30 mL/min/1.73m²), as supported by the most recent study 2. In patients with mild to moderate renal impairment (eGFR 30-60 mL/min/1.73m²), no dose adjustment is typically required, and the standard starting dose of 49/51 mg twice daily can be used, with titration to the target dose of 97/103 mg twice daily as tolerated. Entresto should be used with caution in patients with severe renal impairment as clinical experience is limited in this population. Close monitoring of renal function, blood pressure, and serum potassium levels is essential during treatment, particularly during dose initiation and titration periods. The medication works by inhibiting neprilysin (sacubitril) and blocking angiotensin II receptors (valsartan), which can affect renal hemodynamics and electrolyte balance, making careful monitoring especially important in patients with compromised kidney function. Some key points to consider when using Entresto in patients with impaired renal function include:
- The importance of regular monitoring of renal function and electrolyte levels, as supported by studies such as 3 and 4
- The need for cautious titration of the dose in patients with severe renal impairment, as recommended in the study 2
- The potential benefits of Entresto in improving exercise performance and reducing cardiovascular risk in patients with heart failure, as demonstrated in studies such as 5 and 6. Overall, the use of Entresto in patients with impaired renal function requires careful consideration of the potential benefits and risks, as well as close monitoring of renal function and electrolyte levels.