Cardiology · Angiotensin receptor–neprilysin inhibitor (ARNI)
Sacubitril / Valsartan
Dose
Start 49/51 mg BD (or 24/26 mg if low BP/renal), double after 2–4 weeks to 97/103 mg BD.
Mechanism
Neprilysin inhibition ↑ natriuretic peptides + ARB (AT1 block).
Indications
- • HFrEF (replaces ACEi/ARB after stability; PARADIGM-HF)
- • HFmrEF (PARAGON)
Contraindications
- • Concurrent ACEi (36 h washout)
- • Pregnancy
- • History of angio-oedema
- • eGFR <30 (relative)
- • SBP <100
Dose adjustment
eGFR <30 or Child-Pugh B: start 24/26 mg BD
Use
First-choice RAS agent in HFrEF (30% mortality reduction vs enalapril).
Monitoring
BP, U&E, K+ (↑vs ACEi), symptoms of angio-oedema.
Side effects
- • Hypotension
- • Hyperkalaemia
- • Renal impairment
- • Angio-oedema
- • Cough (less than ACEi)
Pregnancy safety
Contraindicated.
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
