Table 3

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-REFStarting dose of sacubitril/valsartanUptitration and target dose
No patient characteristics requiring caution or dose reduction49 mg/51 mg twice dailyUptitration 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 past24 mg/26 mg twice daily
eGFR <30 mL/min/m224 mg/26 mg twice daily
Moderate hepatic impairment (Child–Pugh class B)24 mg/26 mg twice daily
Elderly24 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.