Sacubitril + Valsartan

Sacubitril + Valsartan is a angiotensin receptor-neprilysin inhibitor (arni) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Treatment of chronic heart failure with reduced ejection fraction in adults, usually as part of standard heart failure therapy, to reduce the risk of cardiovascular death and hospitalization for heart failure.
• In some countries, it is also approved for symptomatic heart failure with systemic left ventricular systolic dysfunction in children; use in children should follow a specialist's prescription and local product approval.

Sacubitril + Valsartan is taken by mouth, usually twice daily. The starting dose and dose increases depend on previous ACE inhibitor or ARB use, blood pressure, kidney function, liver function, age, and tolerability. Doctors commonly increase the dose gradually toward a target maintenance dose if blood pressure, potassium, and kidney function allow. Do not start, stop, or change the dose without the prescribing doctor's advice.

• Common effects include low blood pressure, dizziness, light-headedness, tiredness, cough, and increased blood potassium.
• Kidney function may worsen, especially in people with kidney disease, dehydration, or those taking interacting medicines.
• Serious allergic swelling of the face, lips, tongue, or throat (angioedema) can occur and needs emergency medical help.
• Seek urgent care for fainting, severe dizziness, trouble breathing, swelling of the face or throat, or signs of very high potassium such as muscle weakness, palpitations, or abnormal heartbeat.

Use Sacubitril + Valsartan carefully in people with low blood pressure, dehydration, kidney disease, liver disease, high potassium, renal artery stenosis, a history of angioedema, or those taking diuretics or potassium-raising medicines. Blood pressure, kidney function, and serum potassium should be monitored as advised by the doctor. Use this medicine only under the guidance of a registered doctor or pharmacist.

• ACE inhibitors: contraindicated; allow at least a 36-hour washout when switching to or from an ACE inhibitor.
• Other ARBs or aliskiren: may increase risks of low blood pressure, kidney problems, and high potassium; aliskiren is contraindicated in patients with diabetes.
• Potassium supplements, potassium-containing salt substitutes, spironolactone, eplerenone, amiloride, triamterene, and other potassium-raising medicines: increased risk of hyperkalemia.
• NSAIDs such as ibuprofen, diclofenac, or naproxen: may worsen kidney function and reduce blood pressure-lowering effect, especially in elderly or dehydrated patients.
• Lithium: blood lithium levels and toxicity risk may increase; monitoring is needed if used together.
• Diuretics and other blood pressure-lowering medicines: may increase the chance of symptomatic low blood pressure.

• Known hypersensitivity to sacubitril, valsartan, or any component of the medicine.
• History of angioedema related to an ACE inhibitor or ARB.
• Concomitant use with an ACE inhibitor, or use within 36 hours of an ACE inhibitor dose.
• Concomitant use with aliskiren in patients with diabetes.
• Pregnancy, especially after the first trimester, because medicines acting on the renin-angiotensin system can harm or kill the fetus.
• Severe liver impairment, biliary cirrhosis, or cholestasis, where listed in the product information.

Sacubitril + Valsartan should not be used during pregnancy and should be stopped as soon as pregnancy is detected unless a doctor advises otherwise with an alternative plan. It can cause serious fetal harm. Breastfeeding is generally not recommended during treatment because it is not known whether the combination passes into human milk and there may be risk to the infant; discuss safer alternatives with a doctor.

Store tablets at room temperature, away from excess heat, moisture, and direct light. Keep in the original packaging until use and out of the reach of children. Do not use after the expiry date or if the tablets appear damaged.