Arnivas 200mg Tablet 1 Strip

✔️ Arnivas combines two active agents:

Sacubitril (a neprilysin inhibitor)

Valsartan (an angiotensin II receptor blocker or ARB)

Sacubitril is a prodrug that, when metabolized to its active form (LBQ657), inhibits neprilysin—an enzyme responsible for breaking down beneficial vasoactive peptides such as natriuretic peptides. By blocking neprilysin, sacubitril promotes vasodilation, natriuresis, and diuresis, which are beneficial in heart failure.

Valsartan selectively blocks the angiotensin II type 1 (AT1) receptor, inhibiting the harmful effects of angiotensin II, including vasoconstriction and aldosterone release, thereby helping to lower blood pressure and reduce cardiac workload.

Together, the combination exerts synergistic cardiovascular and renal protective effects, making it highly effective in managing heart failure.

✔️ Dosage & Administration

Adults (Heart Failure)

• Initial Dose: 49/51 mg twice daily
• Titration: Increase to 97/103 mg twice daily after 2–4 weeks, depending on tolerance

Dose Adjustment Required In:

• ACEi/ARB-naïve patients or those on low doses: Start with 24/26 mg twice daily
• Severe renal impairment (eGFR <30 mL/min/1.73 m²)
• Moderate hepatic impairment (Child-Pugh B)

Pediatric Dosing (≥1 Year)

<40 kg body weight:

• Start at 1.6 mg/kg twice daily
• Titrate to 2.3 mg/kg, then to 3.1 mg/kg

40–50 kg:

• 24/26 mg → 49/51 mg (no further increase)

≥50 kg:

• 49/51 mg → 72/78 mg → 97/103 mg
• Adjust the dose every 2 weeks based on the child’s tolerance.

Pregnancy and Lactation

• Not recommended during pregnancy or while breastfeeding due to potential harm to the fetus or infant.

Pediatrics

• Safety and efficacy not been established in children <1 year of age.
• Approved for pediatric heart failure in patients ≥1 year.

Geriatrics

• No clinically significant differences in efficacy or safety among patients aged 65 or older, including those over 75.

Renal Impairment

• Severe impairment (eGFR <30): Start at 24/26 mg twice daily
• Mild to moderate: No dose adjustment required

Hepatic Impairment

• Mild (Child-Pugh A): No adjustment needed
• Moderate (Child-Pugh B): Begin at 24/26 mg twice daily
• Severe (Child-Pugh C): Use is not recommended

✔️ Common Side Effects

• Angioedema
• Low blood pressure (hypotension)
• Kidney dysfunction
• Elevated potassium (hyperkalemia)
• Persistent dry cough
• Dizziness or lightheadedness

✔️ Overdose Information

Limited human data available. An overdose may lead to excessive hypotension.

Symptomatic and supportive treatment is recommended.

Due to high protein binding, hemodialysis is unlikely to be effective in removing the drug.

✔️ Drug Interactions

• Do not combine with ACE inhibitors or aliskiren (in diabetic patients) due to the risk of angioedema and renal dysfunction.
• Avoid potassium-sparing diuretics (e.g., spironolactone) as they may increase the risk of hyperkalemia.
• NSAIDs may impair renal function.
• Lithium levels may rise, increasing the risk of toxicity when used together.

✔️ Arnivas is contraindicated in the following situations:

• Known hypersensitivity to sacubitril, valsartan, or any excipients
• History of angioedema linked to ACEi or ARB use
• Use with ACE inhibitors (a 36-hour washout period is required)
• Concomitant use with aliskiren in diabetic patients

✔️

• Monitor closely for angioedema, especially in patients with a history of allergic reactions to ACEi or ARBs.
• This medication may lower blood pressure significantly, especially in volume-depleted patients—monitor and adjust dosage accordingly.
• Renal function and serum potassium should be checked regularly, particularly in patients with diabetes, renal impairment, or on a high potassium diet.

✔️ Storage Instructions

• Store Arnivas in a dry place below 30°C.
• Protect from moisture and keep out of reach of children.