Chronic Diarrhoea associated with Sacubitril-Valsartan use in an Elderly Female - The Benefits of Unprescribing

Sacubitril/Valsartan is a novel Angiotensin Receptor Blocker-Neprilysin Inhibitor (ARNI) approved for the treatment of patients with NYHA class II-IV Heart failure with reduced ejection fraction (HFrEF). Hypotension, renal dysfunction, upper respiratory tract infections and angioedema are the common adverse effects reported with sacubitril/valsartan. Here, we report the first case of chronic non-resolving diarrhoea refractory to conventional therapy in an elderly female on sacubitril-valsartan treatment, which posed a diagnostic challenge. The case highlights the importance of suspecting novel drugs being sparsely used in the elderly population as the aetiology of new symptoms, and conducting a therapeutic de-challenge even in the face of apparently low causality scores.