Which dose of sacubitril/valsartan is appropriate for a patient currently receiving lisinopril at a dose greater than 10 mg?

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The correct dosing for sacubitril/valsartan in a patient transitioning from an ACE inhibitor, such as lisinopril, involves taking into account the current dosage of the ACE inhibitor. For patients already on a stabilized dose of an ACE inhibitor greater than 10 mg, guidelines support starting sacubitril/valsartan at a higher initiation dose, specifically 49/51 mg twice daily.

This initiation dose is beneficial as these patients are likely to have a better tolerance to the effects of the medication, including the potential for side effects related to blood pressure changes and the risk of angioedema. Starting them on the 49/51 mg dose allows for optimal therapeutic effects while still taking into account safety considerations.

The other options represent lower doses that are generally reserved for patients who are either not on an ACE inhibitor or who are on a lower dose of an ACE inhibitor. Thus, they would not be appropriate in the context of a patient receiving a higher dose of lisinopril, as they may not provide adequate therapeutic response or adequate activation of the neprilysin inhibition that sacubitril provides in conjunction with valsartan.

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