NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update


Sacubitril/valsartan (Entresto®) represents a new therapeutic option for patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF). It is prescribed instead of an ACE inhibitor or ARB. Sacubitril enhances the protective neurohormonal systems of cardiac peptides, e.g. natriuretic peptides via its active metabolite, a first in class neprilysin inhibitor.


When compared with ACE inhibitor, sacubitril/valsartan has been shown to significantly reduce rates of the composite outcome of cardiovascular death and hospitalisation for heart failure, rates of the component outcomes and of all cause mortality.


It has been added to the Total Formulary, restricted to:

  • initiation by a consultant with special interest in heart failure
  • patients with heart failure class II to IV who also have LVEF <40% and ongoing symptoms despite optimal treatment (ACEI or ARB, beta blocker and either eplerenone or spironolactone) as outlined in SIGN Guideline 147.


The MCN are preparing practice guidance for prescribers.


Prescribing Notes:

  • Patients commenced on sacubitril/valsartan should have access to a multidisciplinary heart failure team
  • If the patient is already on an ACE inhibitor, the ACE inhibitor must be stopped 36-48 hours before initiating sacubitril/valsartan to minimise the risk of angioedema