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Stand up slowly if you have been sitting or lying down. |
Do not drive a car or operate machinery if it makes you feel dizzy. |
This medication may cause changes in your blood sugar levels. It may also hide your usual signs of low blood sugar. |
If you have diabetes, ask your health care provider how this will affect the way you manage your diabetes. |
Do not change the dose or stop taking this medicine without talking to your doctor and/or pharmacist, even if you feel well. Suddenly stopping this medication can cause serious heart problems. |
Check with your health care provider and/or pharmacist before taking any other medication, vitamin, or herbal remedy in combination with this medicine. |
SACUBITRIL/VALSARTAN (ENTRESTO™) |
Sacubitril/valsartan (Entresto™) is a newer heart failure drug. It is from a class of medications known as ‘angiotensin receptor-neprylisin inhibitors.’ In addition to helping people with heart failure live longer and feel better, it has been shown lower the need to be hospitalized to treat heart failure. |
How Does Sacubitril/Valsartan Work? |
Sacubitril/valsartan is a combination of two medications: sacubitril (a neprilysin inhibitor) and valsartan (an angiotension II receptor blocker, ARB). It has two main actions: |
It works to block the effect of harmful hormones that cause blood vessels to constrict and hold on to salt and water. |
It prevents the breakdown of beneficial hormones that cause blood vessels to relax, allowing the body to get rid of extra salt and water. |
Together, these two effects help to decrease strain on the heart. |
When and How Should I Take This Medication? |
Sacubitril/valsartan is a tablet that is taken twice a day. It can be taken with or without food. It should be taken at the same times each day. |
Sacubitril/valsartan is used in combination with other medications to treat heart failure but must not be taken with ACE Inhibitors or ARBs. If you are taking an ACE Inhibitor, you must stop it and wait a full 36 hours before starting Entresto TM. Your health care provider will talk to you more about this. |
What are Common Side Effects of Sacubitril/valsartan? |
Dizziness or lightheadedness |
An increased blood potassium level. Your health care provider will periodically monitor your blood tests. |
Worsening kidney function. Your health care provider will periodically monitor your blood tests. |
Feeling fatigued or tired. |
Severe side effects may include: |
An allergic reaction, such as rash, hives, and/or blisters |
An irregular heartbeat |
Feeling like you might faint or pass out |
Feeling very weak |
Worsening shortness of breath |
A decrease in the amount of urine that you are passing |
Very rarely, a severe allergic reaction called angioedema can occur. This involves swelling of the face, tongue, lips, and hands. If this happens, you should seek immediate attention |
Call your health care provider immediately if you develop any of these severe side effects. |
What Should I Remember While Taking This Medication? Stand up slowly from a sitting or lying position to avoid getting dizzy. |
Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are already or plan on taking, including vitamins/minerals and herbal supplements. |
Tell your health care provider if you are taking salt substitutes, as they may also contain potassium. |
Taking sacubitril/valsartan with potassium supplements can increase your blood potassium level. Check with your health care provider before using potassium supplements. You may require blood tests to check your potassium level. |
Talk to your health provider if you are pregnant, considering becoming pregnant, or breastfeeding. Sacubitril/valsartan should not be taken if you are pregnant or breastfeeding. |
ALDOSTERONE ANTAGONISTS |
Medications in this class include: |
Spironolactone (Aldactone®) |
Eplerenone (Inspra®) |
How Do Aldosterone Antagonists Work? |
Aldosterone antagonists (also known as ‘mineralocorticoid antagonists’) block hormones that put stress on your heart. They are also a diuretic, so they help rid your body of extra fluid. |
What Are the Common Side Effects? |
Feeling fatigued. This should improve as your body gets used to the medication |
Increased potassium and worsening kidney function. This will be monitored with blood tests. |
Breast enlargement or tenderness in men (especially with Spironolactone). |
Passing more urine. |
Stomach cramps or diarrhea. You can take it with food to avoid an upset stomach. |
Nausea and vomiting |
What Should I Remember While Taking Aldosterone Antagonists? |
Take at the same time(s) each day, with or without food. |
Use cautiously if you have certain types of kidney problems. Check with your health care provider first. |
Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking. |
Check with your health care provider before using potassium supplements. You may require extra blood tests to measure the amount of potassium in your blood. |
If you develop another illness and are not able to eat or drink, or if you are experiencing a lot of vomiting or diarrhea, contact your health care provider or pharmacist. Extra blood tests may be needed to check your potassium levels. In some cases, the medication may need to be paused for a few days until you are feeling better. Do not stop any of your medications without speaking to your health care provider. |
SODIUM GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS |
Medications in this class include: |
Dapagliflozin (Forxiga) |
Empagliflozin (Jardiance) |
Canagliflozin (Canagliflozin) |
How do SGLT2 Inhibitors Work? |
SGLT2 Inhibitors cause the kidneys to eliminate sodium and glucose (salt and sugar) from the blood stream. This results in less fluid retention and slightly reduced blood pressure. These medications also have other favorable effects on the heart and blood vessels, which contribute to a lower risk of hospitalization and improved survival. |
Because SGLT2 inhibitors result in more elimination of glucose in the urine, they improve blood sugar levels. Originally, they were used only to treat patients with type 2 diabetes, however recent studies confirmed their effectiveness for people with heart failure. SGLT2 Inhibitors are still used widely for the treatment of type 2 diabetes to control blood sugar and reduce the risk of developing worsening kidney failure and cardiovascular disease. |
How Should I Take SGLT2 Inhibitors? |
Take this medication at the same time(s) every day. |
Usually, the full dose is prescribed and does not require dose adjustment. Occasionally, your care provider may start with a lower dose before increasing to the target dose of the medication to ensure that it is well tolerated. |
What are the Common Side Effects? |
Reduced blood pressure, resulting in dizziness or lightheadedness |
Increased urine output, similar to diuretic medications |
Genital yeast infections (in men and women) requiring treatment |
Dehydration |
Low blood sugar |
Ketoacidosis (rare). |
What Should I Remember While Taking This Medication? |
SGLT2 Inhibitors can lead to dehydration ― particularly if you have other illnesses that also cause dehydration such as serious infections, diarrhea, or vomiting. It is recommended that SGLT2 inhibitors are paused for a few days in these situations as part of ‘sick day’ management. |
During times of severe illness, rare cases of a serious condition called ‘ketoacidosis’ can occur while taking SGLT2 inhibitors. This can be life-threatening if not treated and requires admission to hospital and discontinuation of this medication. Talk to your healthcare provider about sick day management for SGLT2 inhibitors and other medications. |
Because SGLT2 Inhibitors lower glucose levels, patients who are also taking insulin or other pills to lower blood sugar may need to have doses of their diabetes medications adjusted accordingly. |
Genital yeast infections are more common in patients who take SGLT2 inhibitors. This is usually a non-serious problem but can require treatment with anti-fungal pills or topical medications. Yeast infections occasionally recur, requiring more prolonged therapy. |
IVABRADINE (LANCORA™) |
Ivabradine (Lancora™) |
Ivabradine (Lancora™) is a new class of medication approved for treatment of heart failure. In addition to helping people with heart failure live longer and feel better, it has been shown to lower the need to be hospitalized to treat heart failure. |
Ivabradine is meant to be used in addition to other classes of medication that are useful in treating heart failure. |
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