Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction

Sacubitril valsartan (Entresto, Novartis) has a UK marketing authorisation for 'the treatment of symptomatic chronic heart failure with reduced ejection fraction'. Before the marketing authorisation was granted, sacubitril valsartan was available in the NHS through the early access to medicines scheme. Sacubitril valsartan is an angiotensin receptor neprilysin inhibitor, including both a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (ARB; valsartan). Both sacubitril and valsartan lower blood pressure.

Sacubitril valsartan is administered orally. The recommended starting dose is one 49/51 mg tablet, twice daily (each tablet contains 48.6 mg sacubitril and 51.4 mg valsartan). The dose should be doubled at 2 to 4 weeks to the target dose of one 97/103 mg tablet (97.2 mg sacubitril and 102.8 mg valsartan) twice daily, as tolerated by the patient.

The most commonly reported adverse reactions during treatment with sacubitril valsartan were hypotension, hyperkalaemia and renal impairment. Reported adverse events were generally in line with that reported for other medicinal products acting on the renin-angiotensin-aldosterone system. For full details of adverse reactions and contraindications, see the summary of product characteristics.

The acquisition cost of sacubitril valsartan is as follows (excluding VAT; MIMS, April 2016):

• 24/26 mg (containing 24.3 mg sacubitril and 25.7 mg valsartan), 28 pack: £45.78

• 49/51 mg (containing 48.6 mg sacubitril and 51.4 mg valsartan), 28 pack: £45.78 

• 49/51 mg (containing 48.6 mg sacubitril and 51.4 mg valsartan), 56 pack: £91.56 

• 97/103 mg (containing 97.2 mg sacubitril and 102.8 mg valsartan), 56 pack: £91.56.
  
  Costs may vary in different settings because of negotiated procurement discounts.