Do you or someone in your family have heart failure? If so, you are probably always concerned about the medications your doctor prescribes. When your heart feels a little tired, it is very important to always be aware of the medications that can help it. Today we are going to talk about a relatively new medication that has shown very successful results in treating this condition. That is ARNI.
Simply put, what is ARNI?
ARNI is actually a combination of two drugs. Its full name is Angiotensin Receptor/Neprilysin Inhibitor. Although the name may sound a bit complicated, it is actually quite simple. It is designed to treat patients with heart failure.
The two main components of this medicine are:
1. ARB (Angiotensin II Receptor Blocker): The drug 'Valsartan' belongs to this group.
2. Neprilysin Inhibitor: The drug 'Sacubitril' belongs to this group.
The only ARNI drug currently available in the world that combines these two is Sacubitril/Valsartan . This was approved in 2015.
How does this medicine work inside the body?
Okay, now let's see how these two medications together can help your heart.
Think of the blood vessels in your body as pipes that carry water. Sometimes these pipes become clogged and narrow, making it harder for your heart to pump blood.
- Valsartan (ARB class): This medicine works by relaxing and widening the narrowed blood vessels. It's like widening a clogged pipe. Then the blood can flow throughout the body without any obstruction. This lowers blood pressure.
- Sacubitril (Neprilysin Inhibitor): This does something even more important. Our bodies naturally produce hormones that help our hearts. But an enzyme called 'Neprilysin' destroys these good hormones. Sacubitril stops that bad enzyme from working. When it stops, our bodies can:
- Eliminate unnecessary sodium (salt) from the body through urine.
- Make the blood vessels wider.
- Produce more urine and reduce excess fluid in the body.
Simply put, the combination of these two medications reduces the burden on the heart and makes its work much easier. It's like having two more people come to help a person who is working hard.
Who is ARNI recommended for?
This medication is not for everyone. Your doctor will decide if this medication is right for you based on several factors.
| Eligibility | Description |
|---|---|
| For those with reduced heart pumping ability | If you have been newly diagnosed with Heart Failure and your Ejection Fraction (EF) , a measure of the heart's pumping efficiency, is 40% or less (in a healthy person, this value is around 55%-65%). |
| For those switching from other medications | If you are already taking ACE inhibitors or ARBs for heart failure, you can switch to ARNIs instead. |
Very important: If you are switching from an ACE inhibitor (e.g. Enalapril, Lisinopril) to an ARNI, wait 36 hours after stopping the ACE inhibitor before starting the ARNI. Failure to do so may result in a dangerous allergic reaction (angioedema), which is swelling under the skin. Your doctor will advise you on this.
Benefits of ARNI and reasons to use it
Many people switch to ARNIs because of the side effects, such as persistent cough, that come with older medications like ACE inhibitors. But that's not the only reason. There are many benefits to using ARNIs.
- Increases lifespan: Studies have found that this drug reduces the risk of death related to heart disease.
- Improves quality of life: Reduces symptoms such as fatigue and tiredness, helping you to function normally.
- Controls disease progression: Slows down the rate at which heart failure gets worse.
- Reduces hospitalizations: It has been proven that people who take this medication have fewer hospitalizations for heart failure.
- Improves heart function: One study showed that after taking ARNI for a year, patients' ejection fraction increased from an average of 28% to 38%. This means that the heart's pumping ability improved significantly.
According to a large study, people taking ARNI have a 20% reduced risk of death or hospitalization from heart disease.
Who should not use this medicine?
This medicine is not suitable for some people. If you belong to any of these groups, doctors say you should not take this medicine.
| Status | Reason |
|---|---|
| Pregnant or breastfeeding mothers | Because it could harm the baby. |
| People who have previously had angioedema | If you have previously developed angioedema, a swelling of the face or lips, due to an ACE inhibitor or ARB medication. |
| Those already taking ACE inhibitor/ARB | It is dangerous to take both medications together. |
| People with serious liver disease | This medicine is not suitable if you have poor liver function. |
| People taking Aliskiren | It is not advisable to take ARNI if you are taking Aliskiren with diabetes or kidney disease. |
Let's also learn about side effects.
Like any medicine, ARNI can cause minor side effects. However, not everyone gets them.
- Low blood pressure (Hypotension): You may feel dizzy and light-headed.
- Effects on kidney function: Some people may experience a slight decrease in kidney function.
- Increased potassium levels in the blood (Hyperkalemia): This can also occur in some people.
- Angioedema: Swelling of the face, lips, and tongue. This is very rare , but can be very dangerous if it occurs.
This is why your doctor will check your blood (to check your kidneys and potassium levels) and blood pressure for the first few weeks when you start taking this medicine. If there are any problems, your doctor will reduce the dose or tell you what to do. Never stop taking this medicine without your doctor's advice.
These side effects usually go away within two weeks. If they persist, inform your doctor immediately.
When should I see a doctor?
If you experience any of these symptoms while taking ARNI, be sure to talk to your doctor.
- Frequent dizziness
- Lightheadedness
- Sometimes fainting
- Very low blood pressure (if the systolic reading is below 90)
You may be a little scared to switch to a new medication when you're used to an old one. But learning about new, effective treatments and talking to your doctor about their pros and cons is very important for your health.
Take-Home Message
- ARNI is a successful, modern drug made up of a combination of two drugs for the treatment of heart failure.
- This dilates blood vessels, removes unnecessary salt and water from the body, and reduces the burden on the heart.
- This medicine provides many benefits, including increased lifespan, improved quality of life, and reduced hospitalizations.
- This medicine is not suitable for pregnant women, those who have previously had angioedema, and those with certain other medical conditions.
- Side effects such as dizziness and low blood pressure may occur. Therefore, it is important to be under the constant supervision of a doctor.
- Never start or stop taking this medicine without medical advice. If you have any problems, contact your doctor immediately.
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