Sacubitril with valsartan (Entresto): heart failure tablet

Entresto contains two active ingredients, sacubitril and valsartan. The SmPC describes it as indicated for symptomatic chronic heart failure with reduced ejection fraction in adults, and for left ventricular systolic dysfunction in children aged one year and above.

Because the dose is stepped up over several weeks, your care team will usually tell you exactly which strength to take and when to move on to the next.

The recommended starting dose is one 49/51mg tablet twice daily, increased over 2 to 4 weeks as tolerated up to 97/103mg twice daily. A lower starting dose of 24/26mg twice daily is suggested for people with systolic blood pressure between 100 and 110mmHg or who have not previously taken an ACE inhibitor.

Do not adjust the dose yourself. Your team will check blood pressure, potassium and kidney function as the dose goes up.

The SmPC states that concomitant use with ACE inhibitors is contraindicated, as is use within 36 hours of stopping an ACE inhibitor. Angioedema is a swelling of the face, lips or throat, and a history of it is also a contraindication, along with severe liver impairment and use with aliskiren in people with diabetes or kidney impairment.

If you are switched from an ACE inhibitor, your clinician will give clear instructions on when to take your last ACE inhibitor tablet and the first Entresto tablet.

Blood pressure should be checked regularly, since symptomatic low blood pressure is more likely if you are short of fluid, for example after vomiting, diarrhoea or high-dose diuretics. Serum potassium and kidney function need periodic assessment, particularly in people at higher risk.

Report dizziness, fainting, a swollen face, lips or tongue or difficulty breathing. Swelling of the face or throat is an emergency requiring 999.

The SmPC says use is contraindicated in the second and third trimesters of pregnancy. Breastfeeding is not recommended because there is insufficient safety data in newborns.

If you could become pregnant, speak to your doctor about contraception before starting.

Patient leaflets for each strength are available from the electronic medicines compendium and are supplied with your pack. Suspected side effects can be reported through the MHRA Yellow Card scheme.

Do not stop or change the tablets without speaking to your team.

If you are moving from an ACE inhibitor to Entresto, write down the exact day and time of your last ACE inhibitor tablet and the planned time of your first Entresto dose, so the 36-hour gap is respected. If you have had swelling of the face, lips or throat in the past with any medicine, say so before the switch.

At follow-up visits expect your blood pressure to be measured and a blood test for potassium and kidney function. Report any days when you have been vomiting, have had diarrhoea or have not been drinking, because low fluid levels make symptomatic low blood pressure more likely. Bring the leaflet and your tablet strengths with you.