Entresto is a compound preparation used for the treatment of heart failure and hypertension, with clear indications and special population contraindications and dosage adjustments. The following will explain from two aspects: indications and medication precautions.

1. Indications

(1) Heart failure

Suitable for adult patients with chronic heart failure and reduced ejection fraction, it can reduce the risk of cardiovascular death and hospitalization for heart failure. When replacing ACEI or ARB, a wash off period of 36 hours is required.

(2) Hypertension

As a treatment drug for adult primary hypertension, it is especially suitable for patients with heart failure or diabetes nephropathy. When single drug control is poor, other antihypertensive drugs can be combined.

2. Medication precautions

(1) Taboo population

Prohibited for individuals allergic to sacubitril or valsartan; Prohibited in the middle and late stages of pregnancy; Combination with ACEI requires a 36 hour interval; Use with caution in patients with severe liver and kidney dysfunction.

(2) Dose adjustment

The initial dose is usually 50mg bid, gradually increasing to 200mg bid based on blood pressure and tolerance. Elderly or kidney injury patients should start from 25mg of body weight.

(3) Adverse reaction monitoring

Common hypotension, hyperkalemia, and renal dysfunction require weekly monitoring of blood pressure, blood potassium, and creatinine during the initial stages of medication, and monthly monitoring after stabilization.

(4) Special populations

Women of childbearing age need to take contraceptive measures; Suspend medication during lactation; The safety of children has not been established; Patients with liver dysfunction need to reduce their dosage by 50%.

(5) Drug interactions

Avoid using potassium sparing diuretics and NSAIDs in combination; When used in combination with lithium agents, blood lithium concentration needs to be monitored; Strong CYP3A4 inhibitors may increase blood drug concentrations.