A neprilysin inhibitor given combined with valsartan (sacubitril/valsartan)
Sacubitril
A neprilysin inhibitor used only in a fixed combination with valsartan to treat heart failure.
What is Sacubitril?
Sacubitril is a heart-failure medicine that is never used on its own — it comes in a fixed combination with valsartan, written as sacubitril/valsartan. The sacubitril part blocks an enzyme called neprilysin, while valsartan acts like an ARB, and together they help the heart cope better in heart failure. The main things to watch for are low blood pressure, a rise in blood potassium and effects on the kidneys, and, less commonly, angioedema (swelling). Importantly, it must not be taken with an ACE inhibitor, and a washout gap is needed when switching from one.
Education and reference only. This is a plain-language guide to Sacubitril — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Sacubitril is a medicine used to treat heart failure, but it is only available combined with another medicine called valsartan, as a single tablet known as sacubitril/valsartan. Sacubitril is a neprilysin inhibitor, and valsartan belongs to the ARB group. The combination is used for adults with certain types of long-term heart failure to improve symptoms and reduce the chance of being admitted to hospital. It is taken by mouth, usually twice a day, and is started and adjusted under the care of a doctor, often a heart-failure specialist or team.
How it works
In heart failure, the heart struggles to pump blood as well as it should. Sacubitril blocks an enzyme called neprilysin, which lets helpful natural substances that relax blood vessels and help the body get rid of salt and water last longer. The valsartan part blocks the effects of a hormone that tightens blood vessels and strains the heart. Working together, the two parts ease the load on the heart and help it work more efficiently. Because both actions can lower blood pressure and affect the kidneys and potassium levels, the dose is built up gradually with monitoring.
Company & origin
Originated / developed by: Novartis.
Used in the UK only as part of a fixed combination with valsartan (sacubitril/valsartan) for heart failure.
What it treats
Conditions Sacubitril is used for
Practical use
How to take Sacubitril
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth as prescribed, usually twice a day, swallowing the tablet with water.
- Never take it together with an ACE inhibitor, and leave the advised gap when switching between them.
- Stand up slowly, especially when you start it or the dose goes up, as it can lower your blood pressure.
- Attend your blood tests so your kidneys and potassium can be checked.
- Seek emergency help if you notice swelling of the face, lips, tongue or throat, or difficulty breathing.
Weighing it up
Advantages & disadvantages of Sacubitril
Advantages
- Improves symptoms and reduces hospital admissions in certain types of heart failure.
- Combines two complementary actions in a single tablet to ease the strain on the heart.
- A well-established option used within specialist heart-failure care.
Disadvantages
- Commonly lowers blood pressure, which can cause dizziness, especially when starting.
- Can raise blood potassium and affect the kidneys, so regular blood tests are needed.
- Must not be combined with an ACE inhibitor, and a washout gap is needed when switching.
Practical use
Good to know
The single most important safety point is that sacubitril/valsartan must not be taken together with an ACE inhibitor, because combining them greatly raises the risk of a serious swelling reaction called angioedema; when switching from an ACE inhibitor, a gap (washout) is needed before starting it, and the other way round too. Low blood pressure is common, especially at first, so you may feel dizzy or lightheaded, particularly on standing. It can raise the level of potassium in your blood and can affect how your kidneys work, which is why blood tests are done before and during treatment. Angioedema, causing swelling of the face, lips, tongue or throat, is uncommon but serious and needs emergency help. Tell your team if you might be pregnant, as it is not suitable in pregnancy.
Who should not take it / use with caution
- People who have had angioedema before, especially linked to an ACE inhibitor or ARB, should not take it.
- It must not be used together with an ACE inhibitor, and is not suitable in pregnancy.
- It is used with caution, or avoided, in people with very low blood pressure, significant kidney problems or high potassium.
Monitoring
- Checking blood pressure, particularly when starting or increasing the dose.
- Regular blood tests for kidney function and potassium.
- Reviewing heart-failure symptoms and overall response over time.
Side effects
- Low blood pressure, causing dizziness or lightheadedness, especially on standing.
- A rise in blood potassium, picked up on blood tests.
- Effects on kidney function, also checked with blood tests.
- Uncommonly but seriously, angioedema (swelling of the face, lips, tongue or throat), which needs emergency help.
Key interactions
- It must not be combined with an ACE inhibitor because of the risk of serious swelling (angioedema).
- Medicines and supplements that raise potassium, including some diuretics and potassium supplements, need care.
- Anti-inflammatory painkillers (NSAIDs) and some other blood-pressure medicines can affect the kidneys and blood pressure when combined.
Available as: Tablets taken by mouth, combining sacubitril with valsartan.
Answers
Sacubitril: frequently asked questions
What is sacubitril used for?
It is used to treat heart failure, but only as part of a fixed combination with valsartan (sacubitril/valsartan), to improve symptoms and reduce hospital admissions.
Can I take it on its own?
No. Sacubitril is only available combined with valsartan in a single tablet; it is not used by itself.
Why can't I take it with an ACE inhibitor?
Combining it with an ACE inhibitor greatly raises the risk of a serious swelling reaction (angioedema), so a washout gap is needed when switching between them.
Why do I need blood tests?
It can raise blood potassium and affect kidney function, so blood tests are done before and during treatment to keep it safe.
What should I do if my face or lips swell?
Swelling of the face, lips, tongue or throat, or difficulty breathing, may be angioedema and is an emergency, so seek urgent medical help straight away.
The wider class
About Neprilysin inhibitor (in combination with valsartan)
Sacubitril belongs to the neprilysin inhibitor (in combination with valsartan) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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