|Population with HF-REF||Starting dose of sacubitril/valsartan||Uptitration and target dose|
|No patient characteristics requiring caution or dose reduction||49 mg/51 mg twice daily||Uptitration by doubling of dose every 2–4 weeks until a target dose of 97 mg/103 mg twice daily is reached.|
|Currently only taking a low or just low target dose of ACE inhibitor or ARB†||24 mg/26 mg twice daily|
|No ACE inhibitor or ARB in the past||24 mg/26 mg twice daily|
|eGFR <30 mL/min/m2‡||24 mg/26 mg twice daily|
|Moderate hepatic impairment (Child–Pugh class B)||24 mg/26 mg twice daily|
|Elderly||24 mg/26 mg twice daily|
†Target doses of ACE inhibitors and ARBs are as follows: ACE inhibitors—captopril 50 mg three times a day, enalapril 10 mg twice daily, lisinopril 20 mg once a day, ramipril 5 mg twice daily, trandolopril 4 mg once a day ARBs—candesartan 32 mg once a day, losartan 150 mg once a day, valsartan 160 mg once a day.
‡The European Medicines Agency also suggests that a dose of 24 mg/26 mg can be considered if eGFR is 30–60 mL/min/m2.33
ARB, angiotensin receptor blocker; eGFR, estimated glomerular filtration rate.