ENTRESTO is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal.
LVEF is a variable measure, so use clinical judgment in deciding whom to treat.
IMPORTANT SAFETY INFORMATION
- When pregnancy is detected, discontinue ENTRESTO as soon as possible
- Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus
GETTING ADULT PATIENTS WITH HF STARTED ON ENTRESTO® IN THE HOSPITAL
- Dose options are 24/26 mg, 49/51 mg, or 97/103 mg administered twice daily. Dose should be titrated up after 2-4 weeks as tolerated by the patient, up to target dose of 97/103 mg twice daily. Recommended starting dose is 49/51 mg twice daily for patients currently taking a high-dose ACEi or ARB†
Additional dosing considerations1:
- If patient is on an ACEi, stop using it for 36 hours (1.5 days) before starting ENTRESTO
- Correct volume or salt depletion prior to administration of ENTRESTO or start at a lower dose
Use a starting dose of 24/26 mg twice daily for1:
- Patients not currently taking an ACEi or ARB or previously taking a low dose of those agents‡
- Patients with severe renal or moderate hepatic impairment
ENTRESTO is contraindicated with concomitant use of an ACEi and in patients with a history of angioedema related to previous ACEi or ARB therapy. Please see Prescribing Information for additional dosing recommendations.
ACEi=angiotensin-converting enzyme inhibitor; ADHF=acute decompensated heart failure; ARB=angiotensin II receptor blocker; BP=blood pressure; EF=ejection fraction; HFrEF=heart failure with reduced ejection fraction; IV=intravenous; LVEF=left ventricular ejection fraction.
*Multicenter, randomized, double-blind trial of in-hospital initiation of ENTRESTO (n=440) compared with enalapril (n=441) among HF patients with reduced EF (LVEF ≤40%) who had been stabilized following admission for ADHF in the US.
†High-dose ACEi: total daily dose of >10 mg of enalapril or therapeutically equivalent dose of another ACEi. High-dose ARB: total daily dose of >160 mg of valsartan or therapeutically equivalent dose of another ARB.4
‡Low-dose ACEi: total daily dose of ≤10 mg of enalapril or therapeutically equivalent dose of another ACEi. Low-dose ARB: total daily dose of ≤160 mg of valsartan or therapeutically equivalent dose of another ARB.4
References: 1. ENTRESTO [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; February 2021. 2. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. 3. Velazquez EJ, Morrow DA, DeVore AD, et al; for the PIONEER-HF Investigators. Angiotensin–neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2019;380(6):539-548. 4. Senni M, McMurray JJV, Wachter R, et al. Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomised comparison of two uptitration regimens. Eur J Heart Fail. 2016;18(9)(suppl):1193-1202. doi:10.1002/ejhf.548. Accessed January 4, 2021. Supplementary material accessed at https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1002%2Fejhf.548&file=ejhf548-sup-0001-AppendixS1.doc