ARNI (Angiotensin Receptor-Neprilysin Inhibitor)

Sacubitril-Valsartan

Brand names: Entresto

Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) used in heart failure with reduced ejection fraction, replacing an ACE inhibitor or ARB.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Sacubitril inhibits neprilysin (raising beneficial natriuretic peptides) while valsartan blocks the angiotensin-II receptor, together improving heart-failure outcomes.

Prescribing in practice

It must NOT be combined with an ACE inhibitor, and at least 36 hours must elapse after stopping an ACE inhibitor before starting it, because of angioedema risk.
Hypotension, hyperkalaemia and worsening renal function can occur — check renal function and potassium.
Avoid in pregnancy and in a history of ACE-inhibitor/ARB angioedema.

Monitoring

Monitor blood pressure, renal function and potassium; review heart-failure status.

Counselling the patient

Report swelling of the face, lips or throat (seek emergency help).
Report dizziness, especially after starting or up-titrating.
Avoid potassium-based salt substitutes.

Evidence & guidelines

Improves outcomes in HFrEF over an ACE inhibitor (PARADIGM-HF) and is recommended within guideline-directed therapy (NICE NG106/TA388).

Reference: PARADIGM-HF (McMurray et al, NEJM 2014); NICE TA506; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways