Neprilysin Inhibitor

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Page Contents

Page Contents...
Indications
Mechanism
Dosing
Adverse Effects
Drug Interactions
References
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II. Indications

Systolic Dysfunction

III. Mechanism

Neprilysin Inhibitors (e.g. Sacubitril)
1. Blocks neprilysin activity and its breakdown of natriuretic peptides
2. Resulting prolonged natriuretic peptide activity increases vasodilation and Sodium excretion
Sacubitril
1. Prodrug that is metabolized to its active form
Typical Neprilysin Inhibitor use is in combination with Angiotensin Receptor Blocker (e.g. Entresto)
1. Adding an ARB, prevents compensatory Angiotensin activation in response to Sacubitril

IV. Dosing

Sacubitril and Valsartan (Entresto)
1. Valsartan 103 mg salt in Entresto is equivalent to 160 mg salt in Diovan
2. Start at Sacubitril/Valsartan 49/51 mg twice daily
3. Titrate to Sacubitril/Valsartan 97/103 mg twice daily

V. Adverse Effects

Combined with Valsartan (Entresto)
1. Risk of Hypotension (Number needed to harm 21)
2. Risk of Angioedema (Number needed to harm 200)

VI. Drug Interactions

Combined with Valsartan (Entresto)
1. See Valsartan
2. See Angiotensin 2 Receptor Blocking Agent
3. Lithium
  1. Risk of Lithium Toxicity

VII. References

(2015) Presc Lett 22(9): 49
McMurray (2014) N Engl J Med 371(11):993-1004 +PMID:25176015 [PubMed]

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Cost: Medications

entresto (on 7/27/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ENTRESTO 24 MG-26 MG TABLET		$10.18 each
ENTRESTO 49 MG-51 MG TABLET		$10.18 each
ENTRESTO 97 MG-103 MG TABLET		$10.18 each

FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.