Can Entresto (sacubitril and valsartan) be crushed?

Crushing Entresto (Sacubitril/Valsartan) for Administration

Entresto tablets can be crushed and administered through a nasogastric or gastric feeding tube when patients are unable to swallow the medication whole.

Administration Options for Entresto

Crushing and Administration Through Feeding Tubes

• Entresto tablets can be crushed and suspended in water for administration through feeding tubes 1
• For nasogastric/gastric feeding tube administration, crushed tablets should be suspended in water and administered immediately 1
• The FDA label specifically provides instructions for preparing an oral suspension using Entresto tablets, indicating they can be crushed 2

Preparation of Oral Suspension

The FDA label provides specific instructions for preparing an oral suspension using Entresto tablets 2:

1. Transfer Entresto tablets into a mortar
2. Crush the tablets into a fine powder using a pestle
3. Add Ora-Plus and triturate gently for 10 minutes to form a uniform suspension
4. Add Ora-Sweet SF and triturate for another 10 minutes
5. Transfer the contents to an amber-colored bottle
6. The prepared suspension can be stored for up to 15 days at room temperature

Important Considerations When Crushing Entresto

Administration Site

• Entresto should be administered through a nasogastric or gastric tube 1
• Administration distal to the stomach should be avoided as it may result in reduced absorption 1

Timing of Administration

• After crushing and suspending in water, Entresto should be administered immediately 1
• For the 15 mg and 20 mg tablets, administration should be followed immediately by enteral feeding 1

Monitoring After Administration

• Monitor for common side effects, particularly hypotension (14% incidence vs. 9.2% with enalapril) 3
• In patients with low blood pressure, careful monitoring is necessary as crushed Entresto may potentially affect absorption rates 1

Patient Populations Requiring Special Consideration

Patients with Renal Impairment

• For patients with severe renal impairment (eGFR less than 30 mL/min/1.73 m²), start with half the usually recommended dose 2
• No dose adjustment needed for mild or moderate renal impairment when administering crushed Entresto 2

Patients with Hepatic Impairment

• For patients with moderate hepatic impairment (Child-Pugh B), start with half the usually recommended dose 2
• No dose adjustment needed for mild hepatic impairment 2
• Not recommended for patients with severe hepatic impairment 2

Contraindications and Precautions

• Entresto is contraindicated with concomitant use of ACE inhibitors 2
• Allow a washout period of 36 hours between ACE inhibitor and Entresto 2
• Monitor for hypotension, particularly in patients with low baseline blood pressure 1, 3

By following these guidelines, Entresto can be safely administered to patients who cannot swallow tablets whole, ensuring they receive this important medication for heart failure management.