Starting dose and dose titration for sacubitril/valsartan in a variety of patient populations with heart failure and reduced ejection fraction (HF-REF)
| 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.