Aliskiren
Contraindicated
Textbook
Increased risk of hypotension, hyperkalemia, and renal impairment.
Avoid concomitant use.
Source: G&G 14e · p603
Drug reference
Sacubitril with valsartan
ARB · Heart Failure Agent
Also known as Entresto, Sacubitril/Valsartan
ARBHeart Failure Agent
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AliskirenContraindicatedTextbookG&G 14e · p603
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- BenazeprilSevereTextbookG&G 14e
Mechanism
Sacubitril (a prodrug) inhibits the breakdown of natriuretic peptides, resulting in increased diuresis, natriuresis, and vasodilation. Valsartan is an angiotensin II AT1 receptor blocker (ARB), which blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II.
Indications
Symptomatic chronic heart failure with reduced ejection fraction
Dosing
- Adult
- For patients not currently taking an ACE inhibitor or angiotensin II receptor antagonist: Initially 24/26 mg twice daily for 3–4 weeks, increased if tolerated to 49/51 mg twice daily for 3–4 weeks, then increased if tolerated to 97/103 mg twice daily.…
- Renal adjustment
- Manufacturer recommends a starting dose of 24/26 mg twice daily if eGFR less than 30 mL/minute/1.73m2. Also consider this starting dose if eGFR 30 to 60 mL/minute/1.73m2.
- Max dose
- 97/103 mg twice daily
Pharmacokinetics
Bioavailability
Valsartan in this formulation is more bioavailable than other tablet formulations.
Metabolism
Sacubitril is a prodrug.
Drug interactions
Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Benazepril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Captopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalapril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Fosinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Lisinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Moexipril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Perindopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other ARB drugs
Ask House about Sacubitril with valsartan
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Sources: BNF·Verified: 2026-05-13 · House clinical team