Learning Objective
By the end of this section, learners should be able to describe the mechanism of action, therapeutic use, and adverse effects of sacubitril–valsartan in the management of heart failure with reduced ejection fraction (HFrEF).
Sacubitril
Neprilysin Inhibitor
- Neprilysin is an enzyme responsible for the degradation of:
- Atrial natriuretic peptide (ANP)
- Brain natriuretic peptide (BNP)
- These peptides reduce blood pressure primarily by:
- Promoting natriuresis
- Reducing intravascular volume
- Producing vasodilation
- Sacubitril also inhibits the metabolism of bradykinin
Activity
Clinical Use
- Administered in combination with valsartan (an angiotensin receptor blocker)
- This combination is known as an Angiotensin Receptor–Neprilysin Inhibitor (ARNI)
- Indicated for treatment of chronic heart failure with reduced ejection fraction (HFrEF)
Adverse Effects
- Hypotension
- Cough
- Angioedema
