SWITCH TO ENTRESTO IN PLACE OF ACEi [1]
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.
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
- Sauer Al, et al. Practical guidance on the use of sacubitril/valsartan for heart failure. Heart Fail Rev. 2019;24(2): 167-176.
- 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.
- 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.
- ENTRESTO® Summary of Product Characteristics, Dec 2023.
- McMurray J, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004.
- 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.
- 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.
- 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.
- Damman K, et al. Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure. JACC Heart Fail. 2018;6(6): 489-498.
- 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.