From the Guidelines
Entresto (sacubitril/valsartan) is contraindicated in patients with a history of angioedema, and it should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor. The medication's mechanism of action, which involves neprilysin inhibition, can increase the risk of angioedema, a potentially life-threatening reaction 1. This contraindication is based on the experience with omapatrilat, a neprilysin inhibitor that was associated with a higher frequency of angioedema than ACE inhibitors in clinical trials 1.
Some key points to consider when prescribing Entresto include:
- A history of angioedema related to previous ACE inhibitor or ARB therapy is a contraindication for Entresto use 1
- Concurrent use with ACE inhibitors is strictly contraindicated, and a 36-hour washout period is required when switching between these medications to prevent angioedema risk 1
- Patients with a history of angioedema should not be prescribed Entresto due to the increased risk of recurrence 1
It is essential to carefully evaluate patients for these contraindications before initiating Entresto therapy to minimize the risk of adverse effects and ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. The benefits of Entresto in reducing morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) should be weighed against the potential risks, and alternative therapies should be considered for patients with contraindications 1.
From the Research
Contraindications for Entresto (Sacubitril/Valsartan)
- The provided studies do not explicitly list contraindications for Entresto (Sacubitril/Valsartan) 2, 3, 4, 5, 6.
- However, it can be inferred that Entresto may be contraindicated in patients with a history of angioedema, as angiotensin receptor neprilysin inhibitors can increase the risk of angioedema 3.
- Additionally, patients with severe hyperkalemia may need to be cautious when taking Entresto, as it can increase potassium levels 4, 6.
- Patients with chronic kidney disease may also need to be monitored closely when taking Entresto, as it can affect kidney function 6.
- It is also important to note that Entresto is not recommended for patients with New York Heart Association class IV heart failure with a reduced ejection fraction, due to limited clinical experience in this population 4.