skip to main content

Sacubitril/valsartan initiation — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiovascular TherapeuticsSacubitril/valsartan initiationGPhC CRA

A 68-year-old man with chronic heart failure is prescribed sacubitril/valsartan. He was previously taking ramipril 10 mg daily. What is the most important counselling point regarding the switch?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — He must have a 36-hour washout period after stopping the ACE inhibitor before starting sacubitril/valsartan

When switching from an ACE inhibitor to sacubitril/valsartan, a minimum 36-hour washout period is mandatory to reduce the risk of angioedema. Concurrent use of ACE inhibitors with sacubitril is contraindicated. The starting dose should be low (sacubitril/valsartan 24/26 mg or 49/51 mg) and titrated up. While initiation may be started by a specialist, it does not require hospital admission.

Reference: BNF; NICE NG106 Heart Failure