Sacubitril/valsartan

What is sacubitril/valsartan?

Sacubitril/valsartan is a medicine used to treat heart failure (weak heart). Sacubitril belongs to a class of drugs called neprilysin inhibitors, and valsartan belongs to a class of drugs called angiotensin receptor blockers (ARBs). They work by relaxing blood vessels so that blood can flow more easily, which makes it easier for the heart to pump blood around the body. It also helps the body retain less water.

You may hear sacubitril/valsartan called by its brand name, Entresto. Sacubitril/valsartan comes as a tablet. A liquid (suspension) can be compounded by a pharmacy.

Before giving sacubitril/valsartan to your child

Tell your child's health-care provider if your child:

• has an allergy to sacubitril, valsartan or any component of the formulation

Talk to your child's health-care provider if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• kidney or liver disease
• hyperkalemia (high potassium levels): valsartan can increase the amount of potassium in the body
• a history of angioedema. Signs include:
• swelling of the hands, face, lips, eyes, tongue or throat
• trouble breathing
• trouble swallowing
• unusual hoarseness

How should you give your child sacubitril/valsartan?

• Give sacubitril/valsartan exactly as your health-care provider tells you and talk with your child's health-care provider before you stop giving this medicine for any reason.
• Give sacubitril/valsartan at the same time(s) every day.
• Sacubitril/valsartan can be given with or without food.
• If your child is taking liquid sacubitril/valsartan:
• Shake the bottle well. Measure the dose with the special spoon or syringe your pharmacist gave you.
• If your child is taking sacubitril/valsartan tablets:
• The tablets may be swallowed whole with a full glass of water. If your child cannot swallow whole tablets, speak with your pharmacist.

What should you do if your child misses a dose of sacubitril/valsartan?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long does sacubitril/valsartan take to work?

It may take up to several weeks before sacubitril/valsartan takes its full effect as the dose has to be increased slowly over a few weeks.

What are the possible side effects of sacubitril/valsartan?

Your child may have some of these side effects while they take sacubitril/valsartan.

Check with your child's doctor or nurse practitioner if your child continues to have any of these side effects, if they do not go away, or if they bother your child:

• cough (dry, persistent)
• low blood pressure and feeling dizzy or light-headed

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's health-care provider right away or take your child to Emergency if your child has any of these side effects:

• signs of an allergic reaction, such as rash; wheezing/chest tightness or trouble breathing; or swelling of the mouth, lips, tongue or throat
• signs of kidney problems, such as being unable to pass urine
• signs of a high potassium level, such as irregular or uneven heartbeat
• fainting or passing out

What safety measures should you take when your child is using sacubitril/valsartan?

Before your child has any medical tests, emergency treatment or any kind of surgery, including dental surgery, tell the doctor or dentist that your child is taking sacubitril/valsartan.

Keep all appointments at the clinic or doctor's office so that the doctor or nurse practitioner can check your child's reaction to sacubitril/valsartan. The doctor or nurse practitioner may need to change the dose so that your child is getting the right amount.

Your child may feel dizzy or light-headed when they start taking sacubitril/valsartan, especially after the first dose. Your child should get out of bed or get up from a sitting position slowly after taking the medicine. They should sit or lie down if they feel dizzy.

Dizziness, light-headedness or fainting also may happen if your child exercises or if the weather is hot. Heavy sweating can cause loss of too much water and low blood pressure. Be extra careful during exercise or hot weather. Make sure your child stays well-hydrated to prevent these symptoms from happening.

Your health-care provider may want your child to watch what kinds of food they eat, especially foods high in salt. Your doctor, nurse practitioner or dietitian will tell you and your child what kind of foods to eat and what to avoid. Check with your health-care provider before changing your child's diet in any way.

Talk to your health-care provider before you give your child any potassium supplements or salt substitutes. Salt substitutes usually contain potassium. Giving sacubitril/valsartan with these products can cause high levels of potassium in the body.

There are some medicines that should not be taken together with sacubitril/valsartan, or in some cases, the dose of sacubitril/valsartan or the other medicine may need to be adjusted. It is important that you tell your health-care provider if your child takes any other medications (prescription, over the counter or herbal), including:

• ACE (angiotensin-converting enzyme) inhibitors such as enalapril, ramipril, lisinopril and fosinopril
• ARBs (angiotensin receptor blockers) such as losartan, telmisartan, valsartan and candesartan
• aliskiren
• potassium supplements
• anti-inflammatory medications such as ibuprofen (Advil, Motrin), naproxen (Aleve) and acetylsalicylic acid (ASA; aspirin).
• lithium
• cold and allergy medications

What other important information should you know about sacubitril/valsartan?

• Keep a list of all medications your child is on and show the list to the health-care provider.
• Do not share your child's medicine with others, and do not give anyone else's medicine to your child.
• Make sure you always have enough sacubitril/valsartan to last through weekends, holidays and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills. If your child needs sacubitril/valsartan liquid, it must be made by a pharmacy. Check if your pharmacy is able to make sacubitril/valsartan liquid and ensure that you give them plenty of notice as it may take several days.
• Keep sacubitril/valsartan at room temperature in a cool, dry place away from sunlight. Do NOT store it in the bathroom or kitchen.

Keep sacubitril/valsartan out of your child's sight and reach and locked up in a safe place. If your child takes too much sacubitril/valsartan, call the Ontario Poison Centre at one of these numbers. These calls are free.

• Call 416-813-5900 if you live in Toronto.
• Call 1-800-268-9017 if you live somewhere else in Ontario.
• If you live outside of Ontario, call your local Poison Information Centre.