Sacubitril/Valsartan is a combination drug that treats heart failure by providing a dual mechanism of action. Valsartan, an angiotensin II receptor blocker (ARB), blocks the harmful effects of the renin-angiotensin-aldosterone system. Sacubitril is a neprilysin inhibitor, which increases levels of beneficial natriuretic peptides that protect the cardiovascular system, leading to vasodilation and reduced cardiac stress.
Verdict
A foundational, life-saving medication for treating specific types of heart failure.
HEALTHSPAN IMPACT
Foundational
RISK LEVEL
Moderate
EVIDENCE GRADE
A
MONTHLY COST
$550 - $750
Protocol
- Typically initiated at 24/26 mg or 49/51 mg twice daily.
- Dose is doubled every 2-4 weeks to a target maintenance dose of 97/103 mg twice daily as tolerated.
Flags
- Risk of hypotension (low blood pressure), especially when starting or increasing the dose.
- Can cause hyperkalemia (high potassium levels), requiring regular blood monitoring.
- May cause kidney function to worsen.
- Contraindicated in patients with a history of angioedema related to previous ACE inhibitor or ARB therapy.
- Must not be co-administered with ACE inhibitors due to increased risk of angioedema.
- Fetal toxicity warning; should not be used during pregnancy.