University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, TX, USA.
J Pharm Pract. 2020 Aug;33(4):553-557. doi: 10.1177/0897190019842700. Epub 2019 Apr 16.
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor approved for the treatment of heart failure with reduced ejection fraction (HFrEF). Valsartan is well studied, but sacubitril has much left to understand. This report describes a 31-year-old African American female diagnosed with HFrEF who presented with a 7-day history of psychiatric symptoms following a dose increase in sacubitril/valsartan. Prior to the dose increase, the patient had no history of psychiatric diagnoses, but upon hospital presentation, family described instances of confabulation, paranoia, delusions, hallucinations, and sleep disturbances. Laboratory tests were unremarkable, ruling out infectious processes and illicit substance use. However, cranial computed tomography scans depicted intracranial volume loss abnormal for age with commensurate mild ventricular enlargement. Sacubitril/valsartan was discontinued inpatient, symptoms resolved, and the medication intolerance was documented. Clinical trials involving sacubitril/valsartan lack systematic documentation of cognitive symptoms, but active studies exploring the role of neprilysin inhibition may expand knowledge of possible psychiatric adverse effects.
沙库巴曲缬沙坦是一种血管紧张素受体-脑啡肽酶抑制剂，用于治疗射血分数降低的心力衰竭（HFrEF）。缬沙坦的研究较为充分，但沙库巴曲仍有许多需要了解的地方。本报告介绍了一位 31 岁的非裔美国女性，被诊断为 HFrEF，在沙库巴曲缬沙坦剂量增加后出现了 7 天的精神症状。剂量增加前，患者无精神疾病诊断史，但入院时，家属描述了虚构、偏执、妄想、幻觉和睡眠障碍的情况。实验室检查无明显异常，排除了感染性疾病和非法药物使用。然而，头颅计算机断层扫描显示颅内容积减少，与年龄不相称，伴有轻度脑室扩大。沙库巴曲缬沙坦在院中断药，症状缓解，并记录了药物不耐受。涉及沙库巴曲缬沙坦的临床试验缺乏对认知症状的系统记录，但正在进行的探索脑啡肽酶抑制作用的研究可能会扩展对可能的精神不良影响的认识。
