From the Guidelines
Yes, Entresto (sacubitril/valsartan) can cause hyperkalemia, which is an elevated level of potassium in the blood. This risk occurs because valsartan, one component of Entresto, is an angiotensin receptor blocker (ARB) that inhibits the renin-angiotensin-aldosterone system, reducing potassium excretion by the kidneys. The risk of hyperkalemia is higher in patients with certain conditions such as kidney impairment, diabetes, or those taking other medications that can increase potassium levels, including potassium supplements, potassium-sparing diuretics, or ACE inhibitors. According to a study published in the European Heart Journal in 2018 1, sacubitril/valsartan is listed as one of the drugs that may cause hyperkalemia due to decreased potassium excretion. Patients on Entresto should have their potassium levels monitored regularly, especially when starting the medication or adjusting the dose. Typical signs of hyperkalemia include muscle weakness, fatigue, numbness, and in severe cases, cardiac arrhythmias. If you're taking Entresto, it's essential to follow your healthcare provider's recommendations regarding blood tests and to be aware of dietary sources of potassium that might need moderation. Additionally, a study published in Circulation in 2019 1 highlights the importance of monitoring potassium levels in patients with heart failure and diabetes, as the risk of hyperkalemia is increased in these populations. It is crucial to weigh the benefits of Entresto against the potential risks, including hyperkalemia, and to closely monitor patients to minimize the risk of adverse effects. In clinical practice, the risk of hyperkalemia with Entresto can be managed by regular monitoring of potassium levels, adjusting the dose as needed, and being aware of other medications that may increase potassium levels. Overall, while Entresto can cause hyperkalemia, the benefits of the medication in reducing morbidity and mortality in patients with heart failure outweigh the risks, and with proper monitoring and management, the risk of hyperkalemia can be minimized.
From the FDA Drug Label
Through its actions on the RAAS, hyperkalemia may occur with sacubitril and valsartan [see Adverse Reactions (6. 1)]. Monitor serum potassium periodically and treat appropriately, especially in patients with risk factors for hyperkalemia such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet. Dosage reduction or interruption of sacubitril and valsartan may be required [see Dosage and Administration (2.7)]. Increased amount of potassium in your blood (hyperkalemia). Increased blood potassium levels are common during treatment with Sacubitril and Valsartan Tablets Your doctor will check your potassium blood level during your treatment with Sacubitril and Valsartan Tablets .
Yes, Entresto (sacubitril/valsartan) can cause hyperkalemia.
- Key factors that increase the risk of hyperkalemia include:
- Severe renal impairment
- Diabetes
- Hypoaldosteronism
- High potassium diet
- Monitoring of serum potassium levels is recommended, especially in patients with risk factors for hyperkalemia.
- Dosage reduction or interruption of sacubitril and valsartan may be required if hyperkalemia occurs 2 2 2.
From the Research
Entresto and Hyperkalemia
- Entresto (sacubitril/valsartan) is a combination of neprilysin inhibitor and angiotensin II receptor blocker used in the treatment of heart failure with reduced ejection fraction (HFrEF) 3, 4, 5.
- The use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) can be associated with hyperkalemia, particularly in patients with chronic renal insufficiency 6.
- Sacubitril/valsartan has been shown to have a potential risk of hyperkalemia, especially in patients with end-stage renal disease 7.
- Clinical trials have reported increased occurrences of hypotension and nonserious angioedema with sacubitril/valsartan, but the incidence of hyperkalemia was not significantly higher compared to enalapril 4.
- The risk of hyperkalemia with sacubitril/valsartan is still undefined in patients with end-stage renal disease, and ongoing long-term randomized controlled trials are needed to thoroughly define the effective benefits and/or adverse effects in these patients 7.
Risk Factors and Monitoring
- Patients with chronic renal insufficiency are at higher risk of developing hyperkalemia when using ACEi or ARB therapy, including sacubitril/valsartan 6, 7.
- Monitoring of serum potassium levels is essential when initiating sacubitril/valsartan therapy, especially in patients with risk factors for hyperkalemia 6, 4.
- Clinicians should be aware of the potential risk of hyperkalemia and closely monitor patients for signs and symptoms of hyperkalemia when using sacubitril/valsartan 4.