Vymada
Vymada is Novartis’s sacubitril/valsartan 50/100 mg tablets — the first angiotensin receptor-neprilysin inhibitor (ARNI), marketed as Entresto globally. PARADIGM-HF (2014) established 20% reduction in CV death or HF hospitalisation vs enalapril in HF-REF. First-line replacement for ACEi/ARB in stable HF-REF per 2021 ESC and 2022 AHA/ACC guidelines. CRITICAL: 36-hour washout required when switching from ACE inhibitor (angioedema risk). BNP cannot track response — use NT-proBNP.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Vymada?
Vymada is 50 and 100 mg sacubitril/valsartan tablets from Novartis — an angiotensin receptor-neprilysin inhibitor (ARNI). The sacubitril component inhibits neprilysin (an enzyme that degrades natriuretic peptides, bradykinin, and adrenomedullin), boosting the beneficial vasodilatory and natriuretic peptide pathway; the valsartan component blocks the angiotensin-II receptor, preventing vasoconstriction and aldosterone-driven sodium retention. First-line therapy for HF-REF (EF ≤40%) per 2021 ESC and 2022 AHA/ACC guidelines — replaces ACE inhibitor or ARB in most stable HF-REF patients (PARADIGM-HF 2014 showed 20% lower CV death or HF hospitalisation vs enalapril). Dose: 50 and 100 mg twice daily; titrate every 2-4 weeks to target 97/103 mg twice daily. Absolutely contraindicated in pregnancy, history of ACE-inhibitor or ARB angioedema, and within 36 hours of any ACE inhibitor dose (washout required to avoid angioedema).
📦 Every order is covered by our Reshipment Assurance Policy — if your parcel does not arrive within 20 business days, we reship it.
Why order from MedsBase
Our generic medications are sourced from WHO-GMP certified manufacturers and shipped worldwide in discreet, plain packaging — no medication name on the parcel exterior. Card payments are routed through a regulated processor (statement descriptors include a regulated card-payment processor — never “MedsBase” or any medication name). Crypto and SEPA bank transfer are also accepted. Every order is backed by our Reshipment Assurance Policy.
What Is Vymada?
Vymada is 50 and 100 mg sacubitril/valsartan tablets from Novartis, supplied in 28-84 tablets. Originally Novartis Entresto (2015); the first angiotensin receptor-neprilysin inhibitor (ARNI) class.
How ARNI Works
Two complementary mechanisms:
- Sacubitril (a prodrug activated to LBQ657) inhibits neprilysin, a membrane-bound endopeptidase that degrades natriuretic peptides (ANP, BNP, CNP), bradykinin, and adrenomedullin. Inhibition raises levels of these beneficial peptides, producing vasodilation, natriuresis, anti-fibrotic effects, and reduced sympathetic tone.
- Valsartan blocks the angiotensin-II AT1 receptor, preventing vasoconstriction and aldosterone-driven sodium retention.
- Why combined? Neprilysin also degrades angiotensin-II; isolated neprilysin inhibition therefore raises angiotensin-II. Pairing with an ARB prevents that problem. (An earlier combination, omapatrilat, paired neprilysin inhibition with ACE inhibition and caused unacceptable angioedema rates — which is why ARNI uses ARB instead of ACEi, and why ACE inhibitor washout is required before switching.)
Evidence
PARADIGM-HF (2014) — 8,442 patients with HF-REF (EF ≤40%) already on optimal medical therapy randomised to sacubitril/valsartan or enalapril 10 mg bd. Stopped early for benefit: 20% reduction in CV death or HF hospitalisation (primary endpoint), 16% reduction in all-cause mortality. This was the first therapy to beat a full-dose ACE inhibitor head-to-head in HF-REF. Established ARNI as first-line HF-REF therapy in guidelines since 2016.
PARAGON-HF (2019) — 4,822 patients with HF with preserved ejection fraction (HF-PEF, EF ≥45%); missed its primary endpoint (13% reduction, p=0.06), but subgroup benefit in EF 45-57%. FDA granted a broader HF indication in 2021 including HF-PEF; guidelines more cautiously position ARNI in HF-PEF when EF is modestly reduced.
TRANSITION and PIONEER-HF (2019) — initiating ARNI during acute HF hospitalisation is safe and yields greater NT-proBNP reduction than switching later.
Approved Uses
- Heart failure with reduced ejection fraction (HF-REF, EF ≤40%) — first-line replacement for ACE inhibitor or ARB in most patients
- Heart failure with preserved or mildly reduced ejection fraction — FDA-approved; guideline positioning varies by EF subgroup
- Initiation during acute HF hospitalisation (TRANSITION, PIONEER-HF)
Dosage
Available strengths (mg sacubitril / mg valsartan):
- 24/26 mg (low)
- 49/51 mg (mid)
- 97/103 mg (target)
Typical titration: start 49/51 mg twice daily in patients stable on ACE inhibitor or ARB; start 24/26 mg twice daily in ACE-inhibitor-naive, low-BP, renal impairment, or >75 years. Titrate every 2-4 weeks to 97/103 mg twice daily.
Critical switch rule from ACE inhibitor: allow a 36-hour washout after the last ACE inhibitor dose before starting Vymada — combined ACEi + neprilysin inhibition substantially raises angioedema risk. No washout required from ARB.
Monitoring: BP, potassium, creatinine at baseline, 1-2 weeks, and every 3-4 months. Expect a modest creatinine rise (similar to ACEi/ARB). NT-proBNP for response tracking (note: BNP cannot be used because neprilysin degrades BNP; use NT-proBNP which is not a neprilysin substrate).
Side Effects
- Hypotension — more than ACE inhibitors/ARBs alone; dose-limiting in many patients
- Hyperkalaemia — monitor potassium
- Creatinine rise — expected, similar to ACEi/ARB
- Angioedema — rare (~0.5%); higher in Black patients
- Cough — rarer than with ACEi
- Dizziness, fatigue, fainting
Contraindications
- History of angioedema with ACEi or ARB
- Concurrent use of ACE inhibitor or within 36 hours of last ACEi dose
- Pregnancy (teratogenic — valsartan component)
- Severe hepatic impairment (Child-Pugh C)
- Known hypersensitivity
- Concurrent aliskiren in diabetic patients
Drug Interactions
- ACE inhibitors — CRITICAL. 36-hour washout required before switching to ARNI. Never combine.
- Aliskiren — contraindicated combination in diabetes; avoid otherwise.
- Potassium supplements, potassium-sparing diuretics — additive hyperkalaemia.
- NSAIDs — blunt antihypertensive effect; raise AKI risk (triple-whammy with diuretic).
- Lithium — reduced renal clearance; monitor levels.
- PDE5 inhibitors — additive hypotension risk.
Storage
Store Vymada below 25°C in the original blister pack. Keep out of reach of children.
Frequently Asked Questions
Do I need to stop my ACE inhibitor before Vymada?
Yes — stop the ACE inhibitor and wait 36 hours before starting Vymada. Combined neprilysin inhibition + ACE inhibition causes unacceptable angioedema rates (the lesson from omapatrilat’s failed OVERTURE trial). No washout needed when switching from an ARB.
Will Vymada replace my other HF medications?
No. Vymada replaces the ACE inhibitor or ARB component of HF therapy. Continue your beta-blocker, mineralocorticoid receptor antagonist (spironolactone, eplerenone), SGLT2 inhibitor, and any diuretics unchanged. Modern HF-REF “quadruple therapy” is: ARNI + beta-blocker + MR antagonist + SGLT2i.
Why is my NT-proBNP measured and not BNP?
Neprilysin (which Vymada inhibits) degrades BNP but not NT-proBNP. On ARNI therapy, BNP levels rise artificially (because it’s less degraded), obscuring the measure. NT-proBNP is a cleavage product that is not a neprilysin substrate, so it continues to reflect HF severity on ARNI therapy.
Can I take Vymada in pregnancy?
No — the valsartan component is teratogenic (fetal renal agenesis, oligohydramnios). Stop ARNI before planned pregnancy or at confirmation of unplanned pregnancy.
Where can I buy Vymada online?
You can buy Vymada (sacubitril/valsartan 50 and 100 mg, 28-84 tablets) from MedsBase with discreet packaging and worldwide shipping.
Related Cardiovascular Medications
- Abana — Ayurvedic cardiac formulation
- Ambrican — Ambrisentan 5 mg (ERA for PAH)
- Cardace — Ramipril (ACE inhibitor)
- Cordarone — Amiodarone 100/200 mg
- Lonitab — Minoxidil 5 mg (oral vasodilator)
- Xarelto 20 — Rivaroxaban 20 mg (DOAC)
- Browse all High Blood Pressure Medications
More options in High Blood Pressure Medication
Ranked by recent MedsBase order volume — what other customers in this category are picking.
| Strength | 50 mg, 100 mg |
|---|---|
| Quantity | 28 Tablet/s, 56 Tablet/s, 84 Tablet/s |
| Pharma Form | Tablet/s |
| Manufacturer | Novartis India |
| Treatment | Heart failure |
| Generic Brand | Sacubitril + Valsartan |
Vymada
Q & A
Vymada
Related products
Reviews
There are no reviews yet