1. SWITCH TO ENTRESTO IN PLACE OF ACEi

SWITCH TO ENTRESTO IN PLACE OF ACEi

Your eligible HFrEF patients may experience the benefits of ENTRESTO® regardless of their previous therapy.1

Transitioning to ENTRESTO® in symptomatic patients with fewer symptoms and complications can make the process even smoother.1 Here is a checklist of important points to remember and things to consider when switching to ENTRESTO® in place of ACEi.

Stop ACEi2,3
Allow for a 36-hour washout period when switching from an ACEi1,4
The combination of ENTRESTO® with an ACEi is contraindicated due to the increased risk of angioedema4
Inform patients to dispose of their ACEi medication safely (preferably with their local pharmacist)4
Start ENTRESTO®
Prescribe an initial dose of ENTRESTO® after consulting with the SmPC1
Uptitrate every three to four weeks, as tolerated, until the target dose of ENTRESTO® is reached1,4

Recommended ENTRESTO® posology in HFrEF patients switching from ACEi

This dosing schedule shows how eligible patients with HFrEF could be titrated to the target dose of ENTRESTO®.4

Recommended starting dose for patients not taking or on low dose of ACEi/ARB

50 mg

To be taken twice daily, as tolerated by the patient.
Follow up in 3-4 weeks.

Recommended starting dose (or uptitrate from 50 mg)

100 mg

To be taken twice daily, as tolerated by the patient.
Follow up in 3-4 weeks.

TARGET DOSE

200 mg

To be taken twice daily, as tolerated by the patient.

Which patients can benefit from ENTRESTO®?

A switch to ENTRESTO® may be beneficial for more HFrEF patients than you might think. You may encounter these four HFrEF patients who can all benefit from ENTRESTO®:

PERCEIVED STABLE PATIENT ON ACEi

Consider starting ENTRESTO® in symptomatic patients with fewer symptoms and complications1,5-7

ELDERLY PATIENT ON ACEi

ENTRESTO® has no upper age limit4,8

PATIENT WITH RENAL IMPAIRMENT ON ACEi

ENTRESTO® can be used in the following patients:†4,9

  • eGFR 60-90 ml/min/1.73 m2: no dose adjustment
  • eGFR 30-60 ml/min/1.73 m2: half of the starting dose

PATIENT WITH LOW SYSTOLIC BLOOD PRESSURE ON ACEi

  • ENTRESTO® can be used from SBP ≥100 mmHg‡2,10
  • For patients with SBP 100 – 110 mmHg consider a starting dose of 50 mg4

Footnotes

† As there is very limited clinical experience in patients with severe renal impairment (eGFR <30 ml/min/1.73 m2) (see section 5.1), ENTRESTO® should be used with caution and half of the starting dose is recommended.3

‡ ENTRESTO® should not be initiated unless SBP is ≥100 mmHg for adult patients. A starting dose of 50 mg twice daily should be considered for patients with SBP ≥100 to 110 mmHg. For full guidance on management strategies for hypotension, see ENTRESTO® SmPC4

Abbreviations

ACEi: angiotensin-converting enzyme inhibitor; eGFR: estimated glomerular filtration rate; HF: heart failure; HFrEF: heart failure with reduced ejection fraction; SBP: systolic blood pressure

References

  1. Sauer Al, et al. Practical guidance on the use of sacubitril/valsartan for heart failure. Heart Fail Rev. 2019;24(2): 167-176.
  2. McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
  3. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation 2022;145(18):895-e1032.
  4. ENTRESTO® Summary of Product Characteristics, Dec 2023.
  5. McMurray J, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004.
  6. DeVore AD, et al. Initiation of Angiotensin-Neprily sin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial (supplementary). JAMA Cardiol. 2020:5(2):202-207.
  7. Solomon SD, et al. Efficacy of Sacubitril/alsartan Relative to a Prior Decompensation: The PARADIGM-HF Trial. JACC Heart Fail. 2016;4(10):816-822.
  8. Jhund PS, et al. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HE. Eur Heart J. 2015;36(38): 2576-2584.
  9. Damman K, et al. Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure. JACC Heart Fail. 2018;6(6): 489-498.
  10. Böhm M, et al. Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitri/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF. Eur Heart J. 2017;38(15): 1132-1143.
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