II. Indications

III. Mechanism

  1. 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
  2. Sacubitril
    1. Prodrug that is metabolized to its active form
  3. 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

  1. 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

  1. 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

VII. References

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Related Studies

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