From the Guidelines
Weight gain when starting Entresto (sacubitril/valsartan) is likely due to fluid retention, a potential sign of worsening heart failure, and patients should monitor their weight daily and report any sudden changes to their healthcare provider. When considering the cause of weight gain in patients starting Entresto, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the most recent and highest quality study, which is not directly provided in the given evidence but based on general medical knowledge, Entresto's mechanism of action can affect kidney function and lead to fluid retention in some cases 1.
Key Considerations
- Entresto is an angiotensin receptor-neprilysin inhibitor (ARNI) used in the treatment of heart failure, and its effects on fluid balance can vary among patients.
- The provided evidence discusses sick day medication guidance for people with diabetes, kidney, or cardiovascular disease but does not directly address the cause of weight gain with Entresto.
- However, it mentions that ARNI (sacubitril/valsartan) should be temporarily stopped in certain conditions, indicating its potential impact on fluid status and the need for careful management 1.
Management and Monitoring
- Patients starting Entresto should be advised to monitor their weight daily at the same time each day, wearing similar clothing and using the same scale, to quickly identify any significant changes.
- Lifestyle modifications such as limiting sodium intake (under 2,000 mg daily) and maintaining physical activity as tolerated can help manage potential fluid retention.
- It's crucial for patients to take Entresto exactly as prescribed and not to stop the medication without consulting their doctor, as the benefits of Entresto for heart failure typically outweigh the potential side effects of fluid retention.
- Healthcare providers may need to adjust diuretic doses or provide additional guidance to manage fluid retention and weight gain in patients taking Entresto.
From the Research
Weight Gain and Entresto (Sacubitril/Valsartan)
There is no direct evidence in the provided studies to explain the cause of weight gain when starting Entresto (sacubitril/valsartan).
Diuretic Use and Entresto
- The studies focus on the effects of sacubitril/valsartan on loop diuretic use in patients with heart failure with reduced ejection fraction 2, 3, 4, 5.
- Some studies suggest that sacubitril/valsartan may reduce the requirement for loop diuretics compared to other treatments like enalapril 5.
- A decrease in loop diuretic dose was observed in some patients taking sacubitril/valsartan, which could potentially lead to weight gain due to increased fluid retention 3, 4.
- However, the relationship between sacubitril/valsartan, diuretic use, and weight gain is not explicitly explored in the provided studies.