Entresto Use in Heart Failure with Hepatic Disease

Dosing and Administration

The American Heart Association, American College of Cardiology, and Heart Failure Society of America recommend Entresto to reduce cardiovascular mortality and hospitalization in HFrEF, with consideration of hepatic function for dosing adjustments 6
In patients with mild-moderate hepatic impairment and HFrEF, Entresto is recommended as a replacement for ACE inhibitors in ambulatory patients who remain symptomatic despite optimal therapy with ACE inhibitor, beta-blocker, and MRA 4, 5

Patients with high-output heart failure from hepatic vascular malformations respond to standard CHF therapy including ACE inhibitors, beta-blockers, diuretics, and digoxin, as per the European Association for the Study of the Liver and the European Heart Society 2
The traditional approach with ACE inhibitors and beta-blockers remains the foundation of therapy in patients with liver disease, according to the European Heart Society and the American Association for the Study of Liver Diseases 2, 3

Measure baseline liver function tests, renal function (eGFR), electrolytes (potassium, magnesium), and blood pressure before initiating Entresto, as recommended by the American College of Cardiology 1
Avoid triple combination of Entresto with ACE inhibitors and MRAs due to significantly increased risk of hyperkalemia and electrolyte disturbances, as warned by the European Heart Society and the American College of Cardiology 1
Ensure 36-hour washout period when transitioning from ACE inhibitors to avoid angioedema, as advised by the American College of Cardiology and the European Heart Society 7
Exercise caution with concomitant use of NSBBs (non-selective beta-blockers) in decompensated cirrhosis, particularly in patients with refractory ascites, as recommended by the European Association for the Study of the Liver 8