What protocol should be followed when transitioning from an ACE inhibitor to sacubitril/valsartan?

The recommended protocol for transitioning from an ACE inhibitor to sacubitril/valsartan involves discontinuing the ACE inhibitor within 36 hours before starting sacubitril/valsartan. This timing is crucial because both medications work on the renin-angiotensin system, and the potential risk of angioedema exists if they are overlapping.

Sacubitril/valsartan, being a neprilysin inhibitor combined with an angiotensin receptor blocker, should not be initiated until sufficient time has passed after the ACE inhibitor has been stopped to minimize the risk of adverse effects. The 36-hour window provides a safeguard against the accumulation of angiotensin II, helping to ensure a safer transition and support optimal therapeutic outcomes in treating heart failure or other conditions.

The other protocols mentioned do not align with this safety standard. Continuing the ACE inhibitor for two days would unnecessarily prolong exposure to both agents. Stopping the ACE inhibitor just 12 hours before starting sacubitril/valsartan may not allow enough time for the ACE inhibitor's effects to diminish, increasing the risk of complications. Reducing the ACE inhibitor dose does not adequately mitigate the risk of overlapping effects and is not a recommended strategy. This structured approach ensures both safety and efficacy in