ARNI: sacubitril/valsartan. Mechanism of action, dosage, indications, side effects

ARNI (Angiotensin II Receptor Blockers Neprilysin Inhibitors) is new drug class that is used for treatment of the heart failure with reduced ejection fraction. Nowadays, this drug class includes combination of sacubitril and valsartan.
Mechanism of action, side effects, dosage, drugs interactions and more see in this video.

[@ibrahimelgendy1688]

Why combination & why So Expesive: Alone for Ht failure why not

[@arapaimagold8088]

It is expensive, but when you got pulmonary oedema. This is the drug that bring relief.

[@nsas955]

sacubitril decreases aldosterone ...so why to add valsartan?

[@provendoctor5386]

to prevent hyperactivation of RAS

[@liztripp1953]

Naji abdel-samad my husband coughs violently and has v tach and v fib, is wearing a defib vest and waiting for one to be implanted, started Entresto in Jan 2020 for CHF, and that is when the coughing and black outs started, right after the Entresto treatment began. I have not found (YET) any mention of this anywhere. Now his cough quickly leads to Laryngospasm and no one is listening to our pleas for help. Do you know or have you heard of this happening before? I’m a RN and have cardiac experience and I bet my entire life savings on the fact this is Entresto or one of the two drugs in it or may be the fact the two drugs are combined. This is no “miracle drug”. It took two video conferences w his cardiologist and me holding up my phone to the screen showing him the website (the Entresto site itself) DID have cough and dizziness as side effects, since he denied knowledge of this. Finally realized it and said stop taking it (he had stopped and I read studies stating cough as side effect but no mention of the severity and consequences of chronic violent coughing). He had a monitor oh when he had his wreck and they think the airbag thumped the chest and his heart returned to some other rhythm after the v fib. I am only seeking answers quickly since he now has panic attacks every night before bed dreading waking to the coughing leading to Laryngospasm. We have not been able to have updraft treatment or 02 at home since his cardiologist “does not do this” and his pcp (new physician-recent graduate) says “we don’t want his heart rate to increase). I mean, what is she thinking happens when his severe and I’m talking violent coughing every night and at least 5 time a day less severe attacks happens?! It is placing more strain on his heart and lungs and just everything that entails! So what if his heart rate increases at this point, the way she is thinking?! By the way, the Laryngospasms last 30 min to an hour, not a minute or two. He turns blue and his pulse ox won’t even register!! He can’t get any albuterol inhaler to do it’s job since the spasms block it. We have tried the massage and the maneuver and the relaxation and on and on. I read on the Entresto site it can take up to 6 months to recover from the cough. It’s been what, going on 5 months and this only has worsened. Please send me in the right direction for information. I don’t want a lawsuit I wasn’t my husband to live and not fear sleep. He cannot talk today. His vocal cords are worn out. I am not doing well from lack of sleep and I have to be able to function to care for him. To advocate for him. He is only 54 & has never been ill before. All new to him. I know in my gut the medication is the reason and that he can have relief but I am a nurse, not a doctor, and I have less knowledge but know enough to know this is bad. Don’t even get cough medication or any suggestions just sending him for a sleep study which will show the obvious... he HAS it and my 5 yr old grandson even recognizes a problem “why does he stop breathing” he asked me. (I’m at the end of my rope and sad and I need help for him, not doctors juggling him around and ignoring this serious problem) All he gets when he goes to ER are updraft treatments which help and his heart rate is fine. It’s INSANE at this point. Actually, it’s cruel. Take a dog to a vet and they get their needs met and their treatment but take my man to a dr and get no answers. We have not slept in four nights now. The ambulance just takes his vitals and he signs not to go or he goes to ER just depends. I hear wheezing and often rubs. Dr says lungs sound great. Realllllly?! Wow. Help please!

[@nsas955]

@@liztripp1953 Dear friend I really feel very sorry for your persistant fear for your husband concerning his spastic cough and persistant laryngospasm.I really do not think that what your husband is complaining of is due to ARNI because sacubitril produces muscle relaxation as is also the effect of AIIB valsartan which s not supposed to produce laryngospasm as is usually seen in ACEI which produce bradykinin . Thus i think that your husband should undergo sleep studies for the pcssibility of being complaining o obstructie seep apnoea .I recommend that he should undergo polysomnography test. Hope you will pass this interval successfuly i wish you good time and luck.

[@adela3939]

Great explanation!!! Profound and to the point, very informative, thanks!!🍭🍬

[@emydan]

Thank you so much for great explanation. Blessings!

[@umeshchandra7078]

Super Discription

[@johnrawlins3748]

Thanks!

[@abdullahk3300]

awesome lecture🤩🤩

[@provendoctor5386]

thanks

[@junea8108]

so helpful!!

[@udlovemusic]

My moms sodium came down.. blood pressure came down.. she started vomitting .. after taking this medicine.. later norad was given to raise her blood pressure which resulted in heart rate to 120.. which created VT episode twice... Second time she couldn't be saved... I am still researching on this drug.. pls connect if u hve more info.. thanks

[@tejasvinipandeyrollno45cla58]

Oni Ukj

[@arapaimagold8088]

Are your mother also on diuretics? I don’t have any problem with sodium level, even when taking it with lasix. However I do take a tab of 400mg potassium to compensate what’s being used to expel water out.

[@udlovemusic]

@@arapaimagold8088 Thanks for your reply

[@eldpadl]

Thanks for the useful lecture!

[@bimalpal9969]

Very good information.

[@NehaSharma-ws3uu]

Nice

[@liztripp1953]

Meant to say, he did not have ventricular arrhythmia prior to Jan which is when he began the Entresto. Every day is worse than day before. We don’t know if it’s best to change cardiologists (I know several and we have a Heart Hospital) but we have to just “start over “ is what I get when I call to ask clinics. It’s as if we’re stuck in a special kind of hell that should never be.

[@lalanono2139]

You mean entresto resulted in arrhythmia? I really want to know is it agood drug to start ? Plz answer 🙏🏻

[@karthickd8251]

Will it help improve EF %

[@33135-k]

no....EF is related to pacemaker

[@karthickd8251]

@@33135-k thanks for thr reply now my mother is implanted with lbbb-p pacemaker., and her EF is 60% . She has one problem though., she consumes vymada 100mg which has a side effect of cough .. any ways to avoid that . ?

[@33135-k]

Ok....I will suggest to take cinnamon green tea instead of cough....

[@33135-k]

Syrups...

[@karthickd8251]

@@33135-k Does green tea helps cough? This is kind of a cardiac cough , due to tablet side effects? Syrup didn’t work much for her .

[@ibrahimelgendy1688]

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