It is normal to feel very scared and anxious when the doctor tells you that your heart is weak, or as we call it, you have a heart failure condition. You know how difficult it is to live with problems like fatigue, swollen legs, and not being able to sleep properly at night even after a little effort. There are times when the side effects like cough that come with some of the old medications given for this condition can be even more frustrating. However, with the advancement of medical science, very successful and new treatments have now come to light for such conditions. One such new class of drugs that has brought relief to many people is ARNI. Let us talk about this simply today.
Simply put, what is ARNI?
While the name ARNI may sound a bit complicated, its meaning is quite simple. ARNI (Angiotensin Receptor/Neprilysin Inhibitor) is a special drug that is made by combining two types of drugs to treat heart conditions. Like two talented athletes playing together on the same team, these two drugs work together to provide great relief to your heart.
These two medications are:
1. ARB (Angiotensin II Receptor Blocker): The name of this is Valsartan.
2. Neprilysin Inhibitor: The name of this is Sacubitril.
Currently, the only ARNI drug in use in Sri Lanka and the world is Sacubitril/Valsartan . This was approved in 2015.
Okay, now let's see how this medicine works inside the body?
To understand this, let's use a simple example. Imagine that the circulatory system in your body is like a system of pipes that carry water to a garden. Your heart is the motor that pumps the water through it.
1. What Valsartan does: In heart failure, these blood vessels (arteries) become constricted and blocked. Then the heart has to work very hard and pump blood (arteries) with great pressure. Valsartan works by dilating and loosening the constricted blood vessels . Then the heart can pump blood throughout the body more easily without having to work so hard. This also controls your blood pressure.
2. What Sacubitril does: This one is a little different. Our bodies naturally produce "good hormones" that help the heart, dilate blood vessels, and help the body get rid of excess salt and water. However, an enzyme called "Neprilysin" (like a bad guy) quickly breaks down and destroys these good hormones. What Sacubitril does is it stops the bad guy, the neprilysin enzyme, from working . Then those good hormones can stay in the body longer and do their good work (lowering blood pressure, removing salt and water).
Simply put, these two medications work together to reduce the burden on the heart, while protecting the natural hormones that help the heart.
Who is this ARNI drug recommended for?
Your doctor will usually decide whether this medication is right for you based on several factors.
- For people with heart failure: You may be started on this medication if you have been newly diagnosed with heart failure and your heart's blood-pumping efficiency (we call this Ejection Fraction ) is 40% or less. (This value for a normal healthy person is around 55% - 65%).
- For those switching from older medications: If you are already taking a heart attack medication such as an ACE inhibitor (e.g. Enalapril, Ramipril) or an ARB (e.g. Losartan, Telmisartan), you may be able to switch to an ARNI instead.
Very important!
If you are switching from an ACE inhibitor (e.g. Enalapril) to an ARNI, you must wait at least 36 hours after stopping the ACE inhibitor before starting the ARNI. If you switch between the two medications without this time interval, you may develop a dangerous allergic reaction called angioedema , which causes swelling of the face and throat. Therefore, it is very important to follow your doctor's instructions exactly.
| Who should not take ARNI? | Description |
|---|---|
| People with previous allergies | If you have previously had an allergic reaction that causes facial swelling (angioedema) after taking an ACE inhibitor or ARB medication. |
| Pregnant and lactating mothers | This medicine is not recommended for use during pregnancy or while breastfeeding. |
| People with serious liver disease | If you have severe liver disease. |
| People taking other medications | If you are already taking other specific medications such as ACE inhibitors or aliskiren. |
What are the benefits of ARNI medicine?
Research has found that ARNI drugs offer several significant advantages over older medications such as ACE inhibitors.
- Increased life expectancy: This drug has been found to reduce the risk of death from heart disease, meaning you can live a healthier life for longer.
- Improved quality of life: This medication helps you carry out your daily activities more easily by reducing symptoms such as fatigue, fatigue, and leg swelling.
- Reduced frequency of hospitalizations: Research has shown that it reduces the risk of frequent hospitalizations due to worsening heart disease by about 20%.
- Restoring heart function: Some patients' heart pumping ability (ejection fraction) improves significantly when taking this medicine for a period of time.
One large study found that if a 55-year-old person uses this drug, they will be able to live an additional 2.1 years without being hospitalized or dying from heart disease.
Should we also be aware of the side effects?
As with any medication, there may be some minor side effects. But don't worry, your doctor will educate you about these.
| Possible side effects | What to do? |
|---|---|
| Low blood pressure (Hypotension) | You may experience dizziness, lightheadedness, or blue eyes. You can talk to your doctor and change the time you take your medication. |
| Effects on kidney function | When you start taking the medication and every few months, your doctor will do a blood test to check your kidney function. If necessary, he or she will adjust the dosage. |
| Increased potassium levels in the blood (Hyperkalemia) | This can also be determined through a blood test. The doctor will be paying close attention to this as well. |
| Angioedema | This is very rare. If you experience swelling of the face, lips, tongue or throat, or difficulty breathing, stop taking the medicine immediately and go to the nearest hospital emergency department (ETU). |
These side effects usually go away in about two weeks. If they don't, tell your doctor. He or she may reduce the dose and then increase it again after a few days. Never stop taking the medicine or change the dose without your doctor's advice.
When should I see the doctor?
If you experience the following symptoms while taking ARNI, inform your doctor.
- If you experience severe dizziness
- If you feel light-headed and your eyes are getting blue
- If you feel like you're losing consciousness
- If your blood pressure reading is below 90 (systolic)
It's normal to feel a little apprehensive about switching to a new medication when you're used to an old one. However, it's also important to consider the benefits that new treatments will bring to your life. Talk to your doctor about this openly. Listen to everything clearly about the pros and cons of this medication, and whether it's right for you. Then you can make an informed decision.
Take-Home Message
- ARNI is a very successful, modern class of drugs that treat heart failure.
- This is a combination of two drugs. One reduces the burden on the heart, and the other protects natural hormones that help the heart.
- ARNIs have the potential to extend life expectancy, reduce hospitalizations, and improve quality of life compared to older drugs.
- If you are switching from an ACE inhibitor to an ARNI, you must leave a 36-hour gap.
- It is very important to have blood tests at the scheduled times as advised by your doctor, as side effects such as low blood pressure and kidney damage can occur.
- Always have an open discussion with your doctor about what treatment is best for you.
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