Why urgency is needed when managing stable heart failure patients such as Bernard – New Zealand Doctor Online

Posted: July 31, 2020 at 12:02 pm

References

1. Ahmed A. Am J Cardiol 2007;99:54953.

2. Taylor JC et al, 2016. Australian Family Physician; 45 (11): 823-827.

3. Calvert MJ et al. Eur J Heart Fail 2005;7:24351.

4. Moser DK et al. Heart Lung 2010;39:37885.

5. Cowie MR et al. ESC Heart Failure 2014;1:11045.

6. Chandra A et al. JAMA Cardiol. 2018 Jun; 3(6): 498505.

7. Desai AS et al. Eur Heart J 2015; 36: 1990-1997.

8. Okumura N et al. Circulation 2016; 133: 22542262

9. McMurray JJ et al. N Eng J Med 2014; 371(11): 993-1004.

10. ENTRESTO New Zealand Data Sheet.

11. Pharmaceutical Schedule Pharmac http://www.pharmac.govt.nz.

Abbreviations

ACEi Angiotensin Converting Enzyme inhibitor, NYHA New York Heart Association, ARB Angiotensin Receptor Blocker, HF Heart Failure, LVEF Left Ventricular Ejection Fraction, ECHO - Echocardiogram, HFrEF Heart Failure with reduced Ejection Fraction, BNP - B-type natriuretic peptide, NT-proBNP - N-terminal (NT)-pro hormone BNP, eGFR - estimated Glomerular Filtration Rate

Minimum Prescribing Information

PRESCRIPTION MEDICINE. Entresto 24mg/26mg, 49mg/51mg, 97mg/103mg (sacubitril/valsartan) film coated tablets. Consult full Data Sheet before prescribing, available from http://www.medsafe.govt.nz. Entresto is fully funded under Special Authority Criteria, please refer to http://www.pharmac.health.nz.

Indication: Treatment of chronic heart failure (NYHA Class II-IV) with reduced ejection fraction. Contraindications: Hypersensitivity to sacubitril, valsartan, or excipients. ACE inhibitors (ACEi). Do not administer within 36 hours of switching from or to an ACEi. Angioedema related to previous ACEi or ARB therapy. Use with aliskiren in Type 2 diabetes (T2D). Severe hepatic impairment, biliary cirrhosis and cholestasis. Pregnancy. Precautions: Caution switching from ACEi or while co-administering with aliskiren in T2D (see Contraindications). Should not be co-administered with an ARB. May cause symptomatic hypotension, especially in those 75 years old, renal disease and systolic BP <112 mmHg or patients with an activated RAAS. Initiation not recommended in systolic BP <100 mmHg. Monitor BP when initiating therapy or during dose titration. If hypotension occurs, dose adjustment of diuretics, antihypertensives, and consider treatment of other causes of hypotension. If hypotension persists, consider dose reduction or temporary interruption. Correct sodium and/or volume depletion before starting treatment. May be associated with decreased renal function; assess renal function before initiation and during treatment. Monitor serum creatinine, and down-titrate or interrupt if a clinically significant decrease in renal function develops. May increase urea and creatinine levels in patients with renal artery stenosis. Not recommended with end-stage renal disease. Should not be initiated and consider discontinuation if the serum potassium level is >5.4 mmol/L. Monitor serum potassium periodically and treat appropriately, especially in patients with risk factors, dosage reduction or interruption may be required. Caution with medications known to raise potassium levels. If clinically significant hyperkalaemia occurs, consider adjusting the dose of concomitant medications. If angioedema occurs, immediately discontinue, and provide appropriate therapy and monitoring until complete and sustained resolution; black patients or patients with a prior history of angioedema may be at higher risk. Caution in NYHA Class IV or in moderate hepatic impairment or with AST/ALT >2X ULN. Use in lactation not recommended. Use contraception during treatment and for 1 week after last dose. Interactions: Aliskiren in T2D, ACEi/ARB. Caution with statins, sildenafil, lithium, potassium-sparing diuretics including mineralocorticoid antagonists, potassium supplements, or salt substitutes containing potassium, NSAIDs including selective COX-2 Inhibitors, frusemide, inhibitors of OATP1B1/B3, OAT3 or MPR2 and metformin. Dosage: Target dose one tablet of 97 mg/103 mg twice daily. Starting dose one tablet of 49 mg/51 mg twice daily. Starting dose one tablet of 24 mg/26 mg taken twice daily recommended for ACEi/ARB naive patients, those with severe renal impairment, moderate hepatic impairment, and in those 75 years old. Double every 2-4 weeks to the target dose. Adverse effects: Very common ( 10%): Hyperkalaemia, hypotension, renal impairment. Common (1 to 10%): Cough, dizziness, renal failure, diarrhoea, hypokalaemia, fatigue, headache, syncope, nausea, asthenia, orthostatic hypotension, vertigo. Uncommon (0.1 to 1%): Angioedema, dizziness postural. Unknown: Hypersensitivity (including rash, pruritus, and anaphylaxis).

Novartis New Zealand Limited, Auckland. Ph 0800 652 422 Registered Trademark

NZ-00758 June 2020, TAPS NA12043, BGA200605

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Why urgency is needed when managing stable heart failure patients such as Bernard - New Zealand Doctor Online

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