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Indications & Uses
Arnis is indicated for:
Pharmacology
Sacubitril + Valsartan is a tablet that combines two drugs: sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin receptor blocker. Sacubitril is a prodrug. Its active metabolite, LBQ657, inhibits neprilysin (neutral endopeptidase; NEP), while valsartan blocks the angiotensin II type-1 (AT1) receptor.
In patients with heart failure, the cardiovascular and renal effects of Sacubitril + Valsartan come from two actions working together. LBQ657 raises the levels of peptides that neprilysin normally breaks down, such as natriuretic peptides. At the same time, valsartan stops angiotensin II from having its effects. It does this by selectively blocking the AT1 receptor, and it also inhibits angiotensin II-dependent aldosterone release.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
For adults with heart failure, the recommended starting dose of Sacubitril + Valsartan is 49/51 mg by mouth twice daily. After 2 to 4 weeks, double the dose to the target maintenance dose of 97/103 mg twice daily, as the patient tolerates it.
Reduce the starting dose to 24/26 mg twice daily for these patients: those not currently taking an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB), or who were taking a low dose of these agents before. The same lower starting dose applies to patients with severe renal impairment and to patients with moderate hepatic impairment.
For pediatric heart failure, refer to Table 1 for the recommended dose in patients aged one year and older. Give the recommended dose by mouth twice daily. Adjust the dose every 2 weeks, as the child tolerates it.
Recommended Dose Titration, Pediatric Patients
Less than 40 kg: starting dose 1.6 mg/kg, second dose 2.3 mg/kg, final dose 3.1 mg/kg.
At least 40 kg and less than 50 kg: starting dose 24/26 mg, second dose 49/51 mg, final dose 49/51 mg.
At least 50 kg: starting dose 49/51 mg, second dose 72/78 mg, final dose 97/103 mg.
Side Effects
Sacubitril + Valsartan most often causes angioedema, hypotension, impaired renal function, hyperkalemia, cough and dizziness.
Cautions & Contraindications
Warnings & Precautions
Sacubitril + Valsartan tablets may cause angioedema. Don't give them to anyone who has had angioedema before with an ACEi or ARB, or to anyone with hereditary angioedema. The tablets lower blood pressure, and this can cause symptomatic hypotension. Watch serum creatinine closely. If a patient's kidney function drops to a clinically significant degree, the dose should be brought down or the tablets interrupted. In patients with renal artery stenosis, monitor renal function. Check serum potassium from time to time and treat it appropriately, especially in patients with risk factors for hyperkalemia, such as severe renal impairment, diabetes, hypoaldosteronism or a high potassium diet. Sacubitril + Valsartan may need a lower dose or an interruption.
Contraindications
Sacubitril + Valsartan must not be used in people who are hypersensitive to any of its components. It must also not be used in people who have had angioedema linked to earlier ACE inhibitor or ARB therapy. It is contraindicated with ACE inhibitors too, so do not give it within 36 hours of switching from or to an ACE inhibitor. And it must not be used together with aliskiren in patients with diabetes.
Pregnancy & Breastfeeding
Pediatric use: Safety and effectiveness haven't been established in children under 1 year of age.
Geriatric use: Researchers saw no relevant pharmacokinetic differences in elderly patients (over 65 years) or very elderly patients (over 75 years) when compared with the overall population.
Hepatic impairment: No dose adjustment is needed when this tablet is given to patients with mild hepatic impairment (Child-Pugh A classification). It isn't recommended in severe hepatic impairment, because no studies have been done in these patients.
Renal impairment: No dose adjustment is needed in mild renal impairment (eGFR 60 to 90 ml/min/1.73 m2) or moderate renal impairment (eGFR 30 to 60 ml/min/1.73 m2). In severe renal impairment (eGFR <30 ml/min/1.73 m2), the recommended starting dose is 24/26 mg twice daily.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Use in Special Populations
Pediatric Use
Safety and effectiveness of Sacubitril + Valsartan in pediatric patients have not been established.
Geriatric Use
No relevant pharmacokinetic differences have been seen in elderly patients (≥65 years) or very elderly patients (≥75 years) compared with the overall population.
Renal Impairment
Severe: Start with 24/26 mg twice daily in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²). Then double the dose of Sacubitril & Valsartan every 2 to 4 weeks, as the patient tolerates it, until the target maintenance dose of 97/103 mg twice daily is reached.
Mild or moderate: No adjustment of the starting dose is needed.
Hepatic Impairment
Moderate: Start with 24/26 mg twice daily in patients with moderate hepatic impairment (Child-Pugh B classification). Then double the dose of Sacubitril & Valsartan every 2 to 4 weeks, as the patient tolerates it, until the target maintenance dose of 97/103 mg twice daily is reached.
Mild: No adjustment of the starting dose is needed.
Severe: Use in patients with severe hepatic impairment is not recommended.
Overdose
There isn't much data on overdose with Sacubitril + Valsartan in people. In healthy volunteers, a single dose of 583 mg sacubitril/617 mg valsartan was studied, and so were multiple doses of 437 mg sacubitril/463 mg valsartan over 14 days. Both were well tolerated. Because the tablet lowers blood pressure, hypotension is the most likely result of an overdose, and treatment should be given for the symptoms. Hemodialysis is unlikely to remove Sacubitril + Valsartan from the body, since it is highly protein bound.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Store Sacubitril + Valsartan in a dry place, below 30°C. Keep it away from moisture, and keep it out of the reach of children.
Drug Interactions
Common questions about Arnis 49 mg+51 mg
What is Arnis 49 mg+51 mg Tablet?
Arnis 49 mg+51 mg Tablet is a medicine that contains Sacubitril + Valsartan. It is made by Eskayef Pharmaceuticals Ltd.
What is Arnis used for?
Arnis is used for: Heart Failure.
What are the side effects of Arnis?
Sacubitril + Valsartan most often causes angioedema, hypotension, impaired renal function, hyperkalemia, cough and dizziness.
Can I take Arnis during pregnancy or while breastfeeding?
Pediatric use: Safety and effectiveness haven't been established in children under 1 year of age. Geriatric use: Researchers saw no relevant pharmacokinetic differences in elderly patients (over 65 years) or very elderly patients (over 75 years) when compared with the overall population. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much Arnis?
There isn't much data on overdose with Sacubitril + Valsartan in people. In healthy volunteers, a single dose of 583 mg sacubitril/617 mg valsartan was studied, and so were multiple doses of 437 mg sacubitril/463 mg valsartan over 14 days. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store Arnis?
Store Sacubitril + Valsartan in a dry place, below 30°C. Keep it away from moisture, and keep it out of the reach of children.
Can I take other medicines with Arnis?
Some medicines can interact with Sacubitril + Valsartan, for example: Aliskiren. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Arnis is already among the lowest-priced brands of Sacubitril + Valsartan at this strength.
Do I need a prescription for Arnis?
Arnis is a prescription (Rx) medicine. Take it as your doctor advises.