ARNI Initiation — EECC MCQ

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EasyCardiac PharmacologyARNI InitiationEECC

A 70-year-old man with HFrEF (LVEF 30%) is started on sacubitril/valsartan. He was previously on ramipril 10 mg daily. What washout period is required between stopping the ACE inhibitor and starting sacubitril/valsartan?

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Correct answer: B — At least 36 hours

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · C = shown as D · B = shown as E

Per BNF and the PARADIGM-HF protocol, a washout period of at least 36 hours is required between the last dose of an ACEi and initiation of sacubitril/valsartan (ARNI) to minimise angioedema risk from combined neprilysin and ACE inhibition. No washout is required from an ARB. Shorter washouts (A, B) risk angioedema. Longer washouts (D, E) are unnecessarily prolonged.

Reference: BNF: Sacubitril with Valsartan