Sacubitril and Valsartan
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| Drug monograph · NCLEX study reference | |
| Trade names | Entresto |
|---|---|
| Therapeutic class | Heart failure agent |
| Pharmacologic class | Angiotensin receptor-neprilysin inhibitor (ARNI) |
| Onset / peak / duration | Peak about 2 hours (sacubitril) and 1.5 hours (valsartan); dosed twice daily. |
| Half-life / level | Half-life about 10 to 12 hours; no routine level. |
| Routes | PO (oral) |
| High-alert (ISMP) | No |
| Black box warning | Yes (see Safety) |
| Antidote / reversal | None specific. |
| Pregnancy / lactation | Contraindicated. |
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Sacubitril and Valsartan (brand name Entresto) — Heart failure agent; Angiotensin receptor-neprilysin inhibitor (ARNI).
Identification
- Therapeutic class: Heart failure agent.
- Pharmacologic class: Angiotensin receptor-neprilysin inhibitor (ARNI).
Pharmacology
- Mechanism of action: Sacubitril inhibits neprilysin (raising beneficial natriuretic peptides) while valsartan blocks AT1 receptors, together reducing fluid overload and cardiac strain.
- Onset / peak / duration: Peak about 2 hours (sacubitril) and 1.5 hours (valsartan); dosed twice daily.
- Half-life / therapeutic level: Half-life about 10 to 12 hours; no routine level.
Clinical use
- Indications: Chronic heart failure with reduced ejection fraction.
- Usual dose, route, frequency: 24/26 mg to 97/103 mg PO twice daily, titrated.
- Maximum dose / adjustments: Max 97/103 mg twice daily; lower starting dose in renal or hepatic impairment; requires a 36-hour washout when switching to or from an ACE inhibitor.
Safety
- Contraindications: History of angioedema, concurrent ACE inhibitor, pregnancy, aliskiren in diabetes.
- Black box warning: Fetal toxicity; discontinue when pregnancy detected.
- Interactions: ACE inhibitors (angioedema, requires washout), potassium-sparing agents, NSAIDs, lithium.
- Pregnancy / lactation: Contraindicated.
- High-alert: No.
Adverse effects
- Common side effects: Hypotension, hyperkalemia, dizziness, cough.
- Serious effects to report: Angioedema, severe hypotension, renal impairment.
- Antidote / reversal: None specific.
Nursing process
- Assessment before administration: Blood pressure, potassium, renal function, confirm ACE inhibitor washout, pregnancy status.
- Interventions during therapy: Ensure 36-hour gap from any ACE inhibitor; titrate slowly.
- Monitor: Blood pressure, potassium, renal function.
- Evaluation / expected outcome: Improved heart failure symptoms and reduced hospitalizations.
Patient teaching
- Patient teaching: Never combine with an ACE inhibitor; report swelling.
- Notify provider if: Facial or throat swelling, fainting, severe dizziness, pregnancy.
- Administration tips: With or without food; twice daily at consistent times.