Drug General Information (ID: DDIH2ZFXO3)
Drug Name			Moexipril		Drug Info		Sacubitril		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antihypertensive Agents				Neprilysin Inhibitors
Structure

Mechanism of Moexipril-Sacubitril Interaction (Severity Level: Major)
Increased risk of angioedema/anaphylactoid reactions Click to Show/Hide Mechanism Graph
Drug Name		Moexipril				Sacubitril
Mechanism		Angioedema				Angioedema
Key Mechanism Factor 1
		Factor Name		Angioedema/anaphylactoid reactions
		Factor Description		Anaphylactoid reaction is a condition in which symptoms similar to an allergic reaction occur, but no immune sensitization is detected. Most commonly, the syndrome begins with skin involvement, usually pruritus, flushing, urticaria, or angioedema. Angioedema is a reaction to a trigger that causes swelling of the tissue below the inner layer of the skin, called the dermis or submucosa, and the swelling can occur on the face, throat, or around the genitals.
Mechanism Description		Increased risk of angioedema by the combination of Moexipril and Sacubitril

Recommended Action
Management		Dual blockade of the RAA system by adding an ACE inhibitor to an angiotensin II receptor antagonist (i.e., valsartan) is considered contraindicated. Use of sacubitril-valsartan or an ACE inhibitor within 36 hours of each other should be avoided.

References
1	Product Information. Micardis (telmisartan). Boehringer-Ingelheim, Ridgefield, CT.
2	ONTARGET Investigators, Yusuf S, Teo KK, et al "Telmisartan, ramipril, or both in patients at high risk for vascular events." N Engl J Med 358 (2008): 1547-59. [PMID: 18700309]
3	Product Information. Entresto (sacubitril-valsartan). Novartis Pharmaceuticals, East Hanover, NJ.