The FDA has approved Entresto (Novartis), an oral fixed-dose combination of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan, to reduce the risk of cardiovascular death and heart failure hospitalization in patients with heart failure with reduced ejection fraction. Sacubitril is the first neprilysin inhibitor to become available in the US.
STANDARD TREATMENT — Patients with symptomatic heart failure with reduced ejection fraction generally take an angiotensin-converting enzyme (ACE) inhibitor, a beta blocker, and an aldosterone antagonist. If volume overloaded, they may take a diuretic as well. An ARB is recommended for patients who cannot tolerate an ACE inhibitor.1
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Rifaximin (Xifaxan – Salix), a minimally absorbed oral antibiotic approved previously to treat travelers' diarrhea and to reduce the risk of recurrent hepatic encephalopathy, has now been approved by the FDA for treatment of irritable bowel syndrome with diarrhea (IBS-D). Eluxadoline (Viberzi – Actavis), a mu-opioid receptor agonist, was also recently approved for IBS-D and will be reviewed in a future issue.
SOME TREATMENTS FOR IBS — Symptoms of IBS can include abdominal pain, bloating, flatulence, diarrhea, and constipation. Extra-intestinal complaints are also common. IBS is subtyped, according to the predominant bowel symptom, as IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), mixed-type (IBS-M), or unclassified (IBS-U). The goal of treatment is symptom control; dietary modifications may help improve symptoms of all subtypes of IBS.