From the FDA Drug Label
In a 7-day valsartan-controlled study in patients with reduced ejection fraction (HFrEF), administration of sacubitril and valsartan resulted in a significant non-sustained increase in natriuresis, increased urine cGMP, and decreased plasma MR-proANP and NT-proBNP compared to valsartan In a 21-day study in HFrEF patients, sacubitril and valsartan significantly increased urine ANP and cGMP and plasma cGMP, and decreased plasma NT-proBNP, aldosterone and endothelin-1.
Entresto (sacubitril/valsartan) may help with diuresis as it has been shown to increase natriuresis in some studies 1.
- The increase in natriuresis was non-sustained in a 7-day study.
- Urine ANP and cGMP were also increased in a 21-day study. However, the clinical significance of these findings is not fully understood and more research may be needed to confirm the effect of Entresto on diuresis.
From the Research
Entresto (sacubitril/valsartan) can help with diuresis in heart failure patients by increasing sodium and water excretion through the kidneys, promoting diuresis and reducing fluid retention, as demonstrated in the most recent and highest quality study, the NATRIUM-HF study 2.
Key Findings
- The NATRIUM-HF study found that patients taking Entresto experienced significant increases in diuresis and natriuresis in response to fluid and sodium expansion, compared to baseline values 2.
- The study also found that symptoms and signs of congestion after the fluid/sodium challenge were significantly decreased at months 2 and 3 compared to baseline 2.
- Additionally, the study found that there was a significant decrease in body weight in subsequent visits when compared to baseline values, indicating improved diuresis and reduced fluid retention 2.
Mechanism of Action
- Entresto works by blocking the harmful effects of the renin-angiotensin-aldosterone system while simultaneously inhibiting the breakdown of beneficial natriuretic peptides, leading to increased sodium and water excretion through the kidneys 3.
- This dual mechanism promotes diuresis and reduces fluid retention, making Entresto a valuable treatment option for heart failure patients with reduced ejection fraction.
Clinical Implications
- Patients taking Entresto may experience improved diuretic response compared to traditional ACE inhibitors or ARBs alone, and may be able to reduce their diuretic doses over time as their heart failure symptoms improve 4.
- However, Entresto is not classified as a primary diuretic medication, and most patients will still require conventional diuretics alongside Entresto 5.
- The NATRIUM-HF study provides strong evidence for the use of Entresto in promoting diuresis and reducing fluid retention in heart failure patients, and supports its use as a valuable treatment option for this patient population.