NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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What is contraindicated with the concomitant use of Sacubitril/Valsartan (Entresto)?

Angiotensin-converting enzyme (ACE) inhibitor
Beta-blockers
Calcium channel blockers
Diuretics

The correct answer is: Angiotensin-converting enzyme (ACE) inhibitor

Sacubitril/Valsartan (Entresto) is a combination medication used to treat heart failure. It is a combination of sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker (ARB). Concomitant use of Sacubitril/Valsartan with an angiotensin-converting enzyme (ACE) inhibitor is contraindicated due to an increased risk of angioedema. Both ACE inhibitors and sacubitril work on the renin-angiotensin-aldosterone system, so combining them can lead to an excessive inhibition of this system resulting in serious adverse effects such as angioedema. Beta-blockers, calcium channel blockers, and diuretics are commonly used in heart failure management and can be used in conjunction with Sacubitril/Valsartan without the same contraindications as ACE inhibitors.