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Pronunciation

sa-KU-bi-tril/val-SAR-tan

Classifications

Therapeutic Classification: vasodilators, heart failure agents

Pharmacologic Classification: angiotensin II receptor antagonists, neprilysin inhibitors

Indications

REMS


Action

  • Sacubitril: a pro-drug converted to LBQ657, its active moiety. LBQ657 inhibits the enzyme neprilysin. Neprilysin degrades vasoactive peptides, including natriuretic peptides, bradykinin, and adrenomedullin resulting in levels of these peptides, causing vasodilation and extracellular fluid volume via sodium excretion.
  • Valsartan: Blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.
Therapeutic effects:
  • Reduction in cardiovascular death and hospitalizations due to HF in adults.
  • Reduction in NT-proBNP concentrations in children.

Pharmacokinetics

Sacubitril

Absorption: 60% absorbed following oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: 94–97%.

Metabolism/Excretion: Rapidly converted to LBQ657, its active form. LBQ657 is not significantly metabolized; 52–68% excreted in urine, primarily as LBQ657; 37–48% excreted in feces, primarily as LBQ657.

Half-Life: Sacubitril: 1.4 hr. LBQ657: 11.5 hr.

Valsartan

Absorption: Absorption in combinations with sacubitril is greater than 10–35% absorbed following oral administration of single-entity formulation.

Distribution: Widely distributed to tissues

Protein Binding: 94–97%.

Metabolism/Excretion: Minimally metabolized by the liver; 13% excreted in urine, 86% in feces.

Half-Life: 9.9 hr.

Time/Action Profile

(plasma concentrations)

ROUTEONSETPEAKDURATION
Sacubitril (PO)unknown0.5 hr12 hr
LBQ657unknown2 hr12 hr
Valsartan (PO)unknown1.5 hr12 hr





Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: hypotension

F and E: hyperkalemia

Neuro: dizziness

Resp: cough

Misc: ANGIOEDEMA

Interactions

Drug-drug:

Route/Dosage

Availability

Assessment

Lab Test Considerations:

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Entresto