Vivanta 50

Indications

This medication is prescribed for:

• Reducing Cardiovascular Risk: Decreases the risk of cardiovascular death and hospitalizations for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
• Pediatric Heart Failure: Treats symptomatic heart failure with systemic left ventricular systolic dysfunction in children aged one year and older.
• Combination Therapy: Used alongside other heart failure treatments, replacing angiotensin-converting enzyme inhibitors (ACEi) or other angiotensin receptor blockers (ARBs).

Pharmacology

This tablet combines two key components:

• Sacubitril: A neprilysin inhibitor, which increases levels of peptides like natriuretic peptides by inhibiting neprilysin via its active metabolite, LBQ657.
• Valsartan: An angiotensin receptor blocker (ARB) that selectively blocks the AT1 receptor, counteracting the effects of angiotensin II and reducing aldosterone release.

Dosage & Administration

• Adults with Heart Failure: Start with 49/51 mg twice daily, increasing to 97/103 mg twice daily after 2-4 weeks if tolerated.
• Patients with Specific Conditions: Reduce starting dose to 24/26 mg twice daily for those not previously on ACEi/ARB, with severe renal impairment, or moderate hepatic impairment.
• Pediatric Heart Failure: Doses are adjusted based on weight. Follow specific dosing guidelines for children aged one year and older.

Interaction

• Avoid Combination: Do not use with ACE inhibitors, aliskiren in diabetic patients, or other ARBs.
• Potassium-Sparing Diuretics: May increase serum potassium levels.
• NSAIDs: Risk of renal impairment may be elevated.
• Lithium: Increased risk of toxicity.

Contraindications

• Hypersensitivity: Contraindicated in patients allergic to any component.
• History of Angioedema: Not suitable for those with a history of angioedema from ACE inhibitors or ARBs.
• Concomitant Use: Avoid use with ACE inhibitors or aliskiren in diabetic patients.

Side Effects

• Common: Angioedema, hypotension, impaired renal function, hyperkalemia, cough, dizziness.
• Rare: Hepatic issues, anemia, blurred vision, increased pancreatic enzymes.

Pregnancy & Lactation

• Pregnancy: Safety not established; limited studies available.
• Lactation: Avoid use during breastfeeding due to minimal drug levels in milk.

Precautions & Warnings

• Angioedema: Monitor closely; avoid if there’s a history of angioedema.
• Hypotension: Monitor blood pressure and renal function; adjust dosage as needed.
• Hyperkalemia: Periodically check serum potassium levels, especially in at-risk patients.

Use in Special Populations

• Pediatric: Safety and effectiveness not established in children under one year.
• Geriatric: No significant pharmacokinetic differences observed in elderly patients.
• Renal Impairment: Adjust starting dose for severe renal impairment.
• Hepatic Impairment: No dose adjustment needed for mild hepatic impairment; not recommended for severe hepatic impairment.

Overdose Effects

• Symptoms: Likely to cause hypotension. Symptomatic treatment is recommended.
• Hemodialysis: Unlikely to remove due to high protein binding.

Storage Conditions

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