What is Sacubitril and Valsartan: Uses, Dosage, Side Effects and More

Sacubitril and valsartan is a combination heart medication that helps your heart pump blood more effectively. This dual-action medicine works by relaxing your blood vessels and helping your heart handle fluid better, making it easier for your weakened heart to do its job.

Your doctor might prescribe this medication if you have heart failure, a condition where your heart struggles to pump enough blood to meet your body's needs. It's designed to help you feel better, stay out of the hospital, and live longer with heart failure.

What is Sacubitril and Valsartan?

Sacubitril and valsartan combines two different heart medications into one pill. Think of it as a team approach where each medicine tackles heart failure from a different angle to give you better results than either could alone.

Sacubitril works by blocking an enzyme that breaks down helpful substances in your body. These substances naturally help your heart and blood vessels work better. Valsartan belongs to a group called ARBs (angiotensin receptor blockers) that help relax your blood vessels.

This combination is sometimes called an ARNI, which stands for angiotensin receptor neprilysin inhibitor. The brand name you might recognize is Entresto, though generic versions are becoming available.

What is Sacubitril and Valsartan Used For?

This medication is primarily used to treat chronic heart failure in adults. Heart failure doesn't mean your heart has stopped working, but rather that it's not pumping as well as it should be.

Your doctor will typically prescribe this if you have heart failure with reduced ejection fraction. This means the main pumping chamber of your heart (left ventricle) isn't squeezing strongly enough to pump adequate blood out to your body.

Sometimes doctors also use this medication for certain children with heart failure, though this is less common. Your healthcare team will determine if this medicine is right for your specific type of heart condition.

How Does Sacubitril and Valsartan Work?

This medication works through a clever dual approach that addresses heart failure from two important angles. It's considered a moderately strong heart medication that can significantly improve how your heart functions.

The sacubitril part blocks an enzyme called neprilysin, which normally breaks down beneficial substances in your body. By blocking this enzyme, more of these helpful substances stay active longer. These substances help your blood vessels relax, reduce fluid retention, and decrease the workload on your heart.

Meanwhile, valsartan blocks receptors for a hormone called angiotensin II. This hormone normally makes your blood vessels tighten and tells your body to hold onto salt and water. By blocking these effects, valsartan helps your blood vessels stay relaxed and reduces fluid buildup.

Together, these actions help your heart pump more efficiently while reducing the strain on this vital organ. Most people start feeling benefits within a few weeks, though the full effects may take several months to develop.

How Should I Take Sacubitril and Valsartan?

You should take this medication exactly as your doctor prescribes, typically twice daily with or without food. Taking it at the same times each day helps maintain steady levels in your system.

You can take these tablets with water, milk, or juice, whatever feels most comfortable for you. If you experience stomach upset, taking it with food might help. There's no specific meal requirement, so you can adjust based on your daily routine and how your body responds.

Swallow the tablets whole rather than crushing, chewing, or breaking them. This ensures you get the proper dose and that the medication works as intended. If you have trouble swallowing pills, talk with your pharmacist about options.

Your doctor will likely start you on a lower dose and gradually increase it over several weeks. This stepwise approach helps your body adjust to the medication and reduces the chance of side effects like dizziness or low blood pressure.

How Long Should I Take Sacubitril and Valsartan For?

This medication is typically a long-term treatment that you'll need to continue indefinitely. Heart failure is a chronic condition, and stopping this medication usually means losing the benefits it provides for your heart function.

Most people need to take this medication for the rest of their lives to maintain the improvements in their heart failure symptoms. Your doctor will monitor you regularly to ensure it continues working well and adjust the dose if needed.

Never stop taking this medication suddenly without talking to your doctor first. Stopping abruptly can cause your heart failure symptoms to return or worsen. If you need to discontinue it for any reason, your doctor will create a plan to do so safely.

Some people may need breaks from the medication if they develop certain side effects, but this should always be done under medical supervision. Your healthcare team will help you weigh the benefits and risks of continuing treatment.

What Are the Side Effects of Sacubitril and Valsartan?

Like all medications, sacubitril and valsartan can cause side effects, though many people tolerate it well. Understanding what to expect can help you feel more confident about your treatment.

The most common side effects you might experience include dizziness, low blood pressure, elevated potassium levels, and cough. These usually happen because the medication is working to change how your heart and blood vessels function.

Here are the more frequent side effects that people report:

• Dizziness or lightheadedness, especially when standing up
• Low blood pressure (hypotension)
• Increased potassium levels in your blood
• Cough that doesn't go away
• Fatigue or feeling more tired than usual
• Kidney function changes

These common side effects often improve as your body adjusts to the medication over the first few weeks of treatment.

There are also some less common but more serious side effects that require immediate medical attention. While these don't happen often, it's important to know what to watch for.

Contact your doctor right away if you experience:

• Severe dizziness or fainting spells
• Swelling of your face, lips, tongue, or throat (angioedema)
• Difficulty breathing or swallowing
• Severe nausea or vomiting
• Unusual weakness or muscle problems
• Signs of kidney problems like decreased urination or swelling

These serious reactions are rare, but they need prompt medical care to ensure your safety and adjust your treatment appropriately.

Who Should Not Take Sacubitril and Valsartan?

This medication isn't suitable for everyone, and your doctor will carefully review your medical history before prescribing it. Certain conditions make it unsafe or less effective to use.

You should not take this medication if you're allergic to sacubitril, valsartan, or any other ingredients in the tablets. If you've had a serious allergic reaction to ACE inhibitors or ARBs in the past, this medication may not be safe for you either.

People with certain medical conditions need to avoid this medication entirely:

• History of angioedema (severe swelling) with ACE inhibitors or ARBs
• Pregnancy or planning to become pregnant
• Severe kidney disease or kidney failure
• Severely low blood pressure
• High potassium levels that can't be controlled
• Certain rare genetic conditions affecting drug metabolism

These conditions can make the medication dangerous or prevent it from working properly, so alternative treatments would be better choices.

Your doctor will also be extra cautious if you have diabetes, mild to moderate kidney problems, liver disease, or if you're taking certain other medications. These situations don't necessarily rule out treatment, but they require closer monitoring and possibly dose adjustments.

Sacubitril and Valsartan Brand Names

The most well-known brand name for this combination medication is Entresto, manufactured by Novartis. This was the first version approved and remains the most commonly prescribed form.

Generic versions of sacubitril and valsartan are now available from various manufacturers. These contain the same active ingredients in the same amounts as the brand-name version, but they may look different and cost less.

Your pharmacy might substitute a generic version unless your doctor specifically writes "brand name only" on your prescription. Both versions work the same way and have the same effectiveness for treating heart failure.

Sacubitril and Valsartan Alternatives

If sacubitril and valsartan isn't right for you, several other heart failure medications can help manage your condition. Your doctor will choose alternatives based on your specific situation and medical history.

ACE inhibitors like lisinopril or enalapril are often used for heart failure and work similarly to the valsartan component. ARBs such as losartan or candesartan are another option that blocks the same receptors as valsartan.

Other heart failure medications your doctor might consider include:

• Beta-blockers like metoprolol or carvedilol
• Diuretics (water pills) to reduce fluid buildup
• Aldosterone antagonists like spironolactone
• Newer medications like SGLT2 inhibitors
• Digoxin for certain types of heart failure

Often, heart failure treatment involves combining several different medications to get the best results. Your doctor will work with you to find the right combination that controls your symptoms while minimizing side effects.

Is Sacubitril and Valsartan Better Than Lisinopril?

Studies show that sacubitril and valsartan is generally more effective than ACE inhibitors like lisinopril for treating heart failure with reduced ejection fraction. This combination medication has been shown to reduce hospitalizations and improve survival more than ACE inhibitors alone.

The major clinical trial that led to this medication's approval found that people taking sacubitril and valsartan had a 20% lower risk of dying from heart failure compared to those taking an ACE inhibitor. They also had fewer hospitalizations for heart failure.

However, "better" depends on your individual situation. Some people tolerate ACE inhibitors better, while others do better with the combination medication. Cost can also be a factor, as generic ACE inhibitors are typically much less expensive.

Your doctor will consider your specific type of heart failure, other health conditions, current medications, and how you respond to treatment when deciding between these options. Both are excellent medications that can significantly improve heart failure outcomes.