sacubitril/valsartan

7 DRUG INTERACTIONS Avoid concomitant use with aliskiren in patients with estimated glomerular filtration rate (eGFR) less than 60. The concomitant use of ENTRESTO with aliskiren is contraindicated in patients with diabetes [see Contraindications (4)] . Avoid use with aliskiren in patients with renal impairment (eGFR less than 60 mL/min/1.73 m 2 ).

Mechanism: Both drugs target the same blood pressure system, which can cause the kidneys to stop working correctly or lead to high potassium levels. This risk is much higher for people with diabetes or existing kidney disease.

What to do: Avoid taking these medications together if you have diabetes or kidney problems. Your healthcare provider will need to monitor your kidney function closely or change your prescription.

( 7.4 ) 7.1 Dual Blockade of the Renin-Angiotensin-Aldosterone System Concomitant use of ENTRESTO with an ACE inhibitor is contraindicated because of the increased risk of angioedema [see Contraindications (4)] . Avoid use of ENTRESTO with an ARB, because ENTRESTO contains the angiotensin II receptor blocker valsartan. The concomitant use of ENTRESTO with aliskiren is contraindicated in patients with diabetes [see Contraindications (4)] .

Mechanism: Entresto already contains the drug valsartan as one of its ingredients. Taking both together would result in a double dose of the same medicine, which increases the risk of side effects.

What to do: Avoid taking these two medications at the same time. Your doctor will likely stop your separate valsartan pill before you start taking Entresto.

( 7.3 ) Lithium: Increased risk of lithium toxicity. 7.4 Lithium Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists. Monitor serum lithium levels during concomitant use with ENTRESTO.

Mechanism: This medication can prevent your body from clearing lithium properly, causing it to build up to unsafe levels. This can lead to lithium poisoning, which is a serious medical condition.

What to do: Your doctor should frequently test your blood to make sure your lithium levels stay in a safe range.

7.2 Potassium-Sparing Diuretics As with other drugs that block angiotensin II or its effects, concomitant use of potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium [see Warnings and Precautions (5.5)] .

Mechanism: Both of these medications cause the kidneys to keep potassium in the body instead of flushing it out. Taking them together can cause potassium to build up to unsafe levels in your blood.

What to do: Your doctor should check your blood potassium levels regularly. Avoid using potassium supplements or salt substitutes that contain potassium unless your doctor tells you otherwise.

7.2 Potassium-Sparing Diuretics As with other drugs that block angiotensin II or its effects, concomitant use of potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium [see Warnings and Precautions (5.5)] .

Mechanism: These drugs both prevent the body from getting rid of potassium through the urine. This can lead to a dangerous buildup of potassium in your bloodstream.

What to do: Monitor your potassium levels closely with blood tests as directed by your healthcare provider. Tell your doctor if you use any salt substitutes or potassium-containing supplements.