When should ARNI not be given in relation to ACE inhibitor administration?

ARNI, or angiotensin receptor-neprilysin inhibitor, is a combination medication that includes sacubitril and valsartan, used in the management of heart failure. When transitioning from an ACE inhibitor to ARNI, it is crucial to avoid administering the two medications too close together due to the risk of angioedema and a potentially significant drop in blood pressure.

The recommended timeframe for switching from an ACE inhibitor to ARNI is to allow for a washout period of at least 36 hours. This period is essential to reduce the risk of side effects associated with the combination of these medications, particularly since both can lead to increased levels of angiotensin II and its effects on the body.

Utilizing this 36-hour window helps ensure that the ACE inhibitor has cleared from the patient’s system before the new medication is introduced. Therefore, administering ARNI within this period could lead to adverse effects, enforced by close monitoring of patients during such transitions. This transition approach is supported by clinical guidelines and is based on pharmacological principles to ensure patient safety during medication changes in heart failure management.