SACUTAN

*Symptomatic chronic heart failure with reduced ejection fraction (patient not taking an ACE inhibitor or angiotensin II receptor antagonist, or stabilised on low doses of any of these agents):* Adult: Initially 26/24 mg twice daily for 3-4 weeks, increased if tolerated to 51/49 mg twice daily for 3-4 weeks, then increased if tolerated to 103/97 mg twice daily. *Symptomatic chronic heart failure with reduced ejection fraction (patient stabilised on an ACE inhibitor or angiotensin II receptor antagonist):* Adult: Initially 51/49 mg twice daily for 2-4 weeks, increased if tolerated to 103/97 mg twice daily, consider a starting dose of 26/24 mg if systolic blood pressure less than 110mmHg.

Severe hepatic impairment, concomitant use of ACE inhibitor; separate administration by 36 hours, systolic blood pressure less than 100 mmHg

Patients with activated renin-angiotensin system who are receiving angiotensin receptor blockers,renal or hepatic impairment

Aliskiren, lithium, drugs that cause hypotension, Ciclosporin, Rifampicin, Tenofovir, it increase the exposure to statins

Anaemia, diarrhoea, gastritis, hypoglycaemia, hypokalaemia, nausea, vertigo hypersensitivity reactions, renal impairment