【藥品性質提示】 根據 2019 AGS Beers Criteria，本藥品為【潛在不適當用藥 (PIM)】，不建議 CKD >stage3 之老年人長期使用。

治療心衰竭 Heart failure: Reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure and reduced ejection fraction

Angiotensin II Receptor Blocker; Neprilysin Inhibitor.

Distribution: Vd: Sacubitril: 103 L; Valsartan: 75 L.
Protein binding: 94% to 97%.
Metabolism:
Sacubitril: Converted to active metabolite LBQ657 by esterases; LBQ657 is not further metabolized to a significant extent Valsartan: Minimally metabolized (~20%; <10% as a hydroxyl metabolite).
Bioavailability: Sacubitril: >60%.
Half-life elimination: Sacubitril: 1.4 hours; LBQ657: 11.5 hours; Valsartan: 9.9 hours.
Time to peak: Sacubitril: 0.5 hours; LBQ657: 2 hours; Valsartan: 1.5 hours.
Excretion: Sacubitril: Urine (52% to 68%, primarily as LBQ657); feces (37% to 48%, primarily as LBQ657).
Valsartan: Urine (~13%, parent drug and metabolites); feces (86%, parent drug and metabolites).

Hypersensitivity to sacubitril, valsartan, or any component of the formulation; history of angioedema related to previous ACE inhibitor or ARB therapy; concomitant use or use within 36 hours of ACE inhibitors; concomitant use of aliskiren in patients with diabetes.

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

It is not known if sacubitril or valsartan are found in breast milk. Due to the potential for serious adverse reactions in the nursing infant, breast feeding is not recommended by the manufacturer.

Cardiovascular: Hypotension
Endocrine & metabolic: Increased serum potassium, hyperkalemia
Renal: Increased serum creatinine
Cardiovascular: Orthostatic hypotension
Central nervous system: Dizziness, falling
Hematologic & oncologic: Decreased hematocrit, decreased hemoglobin
Hypersensitivity: Angioedema
Renal: Renal failure
Respiratory: Cough

Heart failure: Oral: Patients previously taking over 10 mg/day of enalapril or over 160 mg/day of valsartan or equivalent dose of another ACE inhibitor or ARB: Initial: Sacubitril 49 mg and valsartan 51 mg twice daily. Double the dose as tolerated after 2 to 4 weeks to the target maintenance dose of sacubitril 97 mg and valsartan 103 mg twice daily.