Description
Indications
Symptomatic chronic heart failure with decreased ejection fraction.
Dosage
In patients not currently taking an ACE inhibitor or angiotensin II receptor antagonist, or stabilized on low doses of either of these agents: Initially 26/24 mg twice daily for 3-4 wks, increased if tolerated to 51/49 mg twice daily for 3-4 wks, then increased if tolerated to 103/97 mg twice daily. In patients currently stabilized on an ACE inhibitor or angiotensin Il receptor antagonist: Initially 51/49 mg twice daily for 2-4 wks, increased if tolerated to 103/97 mg twice daily, consider a starting dose of 26/24 mg if systolic BP <110 mmHg.
Advice to Patient
Take with or without meals.
Pharmacokinetics
SACUBITRIL: Metabolism: Metabolized by esterases. Bioavailability: >60%. Half-life elimination: 1.4 hrs. Time to peak: 0.5 hrs. Excretion: Urine (52%-68%). Faeces (37%-48%). VALSARTAN: Metabolism: Minimally metabolized. Half-life elimination: 9.9 hrs. Time to peak: 1.5 hrs. Excretion: Urine (approx. 13%). Faeces (86%).
Interactions
ACE inhibitors (avoid), ciprofloxacin, cyclosporine, amifostine, atypical second generation antipsychotic agents, drospirenone, duloxetine, hydrochlorothiazide, levodopa, nitroprusside, NSAIDs, pholcodine, blood pressure lowering agents, potassium-sparing diuretics, low molecular weight heparins, methylphenidate, amphetamines, pentoxifylline, nicorandil, dapoxetine, PDE 5 inhibitors, potassium salts.
Adverse effects
Anaemia, gastritis, diarrhoea, nausea, vertigo, hypoglycaemia, hypokalaemia.
Reviews
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