Common Registration Assessment, Part 1

Sacubitril valsartan titration and twice daily doses for the GPhC assessment

Three original practice questions, with the working shown. Read the stated prescription or plan before calculating.

Published 14 November 2026. Independent revision material, not GPhC questions, not for patient care.

A clinician feeling a patient's pulse at the wrist during a check-up
Photo from Pexels, used under the Pexels licence. It is a stock image and does not show the exercise.

The manufacturer's UK product information for Entresto (sacubitril and valsartan) gives a recommended starting dose of one 49 mg/51 mg tablet twice daily for adult heart failure, doubled at 2 to 4 weeks to the target dose of one 97 mg/103 mg tablet twice daily.

For patients not currently taking an ACE inhibitor or an angiotensin II receptor blocker, or taking low doses of these medicines, the same information recommends a starting dose of 24 mg/26 mg twice daily with slow titration, doubling every 3 to 4 weeks.

Because of the risk of angioedema when used with an ACE inhibitor, Entresto must not be started for at least 36 hours after stopping ACE inhibitor therapy. If a dose is missed, the patient takes the next dose at the scheduled time.

Each question fixes the values needed for its arithmetic. Keep the two component strengths separate and state both the tablet strength and the times of day. All prescriptions and patients here are fictional; these are revision materials, not for patient care.

The method

  1. Start at one 49 mg/51 mg tablet twice daily, or at 24 mg/26 mg twice daily where the product information recommends the lower start.
  2. Double the dose at the stated interval: at 2 to 4 weeks for the usual start, or every 3 to 4 weeks for the lower start.
  3. Aim for the target of one 97 mg/103 mg tablet twice daily.
  4. Count the daily total of each component as twice the tablet strength, morning and evening.
  5. Leave at least 36 hours between the last ACE inhibitor dose and the first Entresto tablet.

Three practice questions

Work each one on paper first, then open the answer. All patients and prescriptions are fictional.

Question 1

A fictional patient starts Entresto at one 49 mg/51 mg tablet twice daily. What is the total daily dose of each component, and what target tablet does the product information give after the first doubling?

Show the answer

Answer: 98 mg sacubitril and 102 mg valsartan daily; one 97 mg/103 mg tablet twice daily

Working: 49 mg x 2 = 98 mg sacubitril and 51 mg x 2 = 102 mg valsartan per day. The product information doubles the dose at 2 to 4 weeks to the target of one 97 mg/103 mg tablet twice daily.

Question 2

A fictional patient is not currently taking an ACE inhibitor or an angiotensin II receptor blocker. What starting dose and titration interval does the product information recommend?

Show the answer

Answer: 24 mg/26 mg twice daily, doubling every 3 to 4 weeks

Working: The product information gives a starting dose of 24 mg/26 mg twice daily with slow titration, doubling every 3 to 4 weeks, for patients not currently taking an ACE inhibitor or an angiotensin II receptor blocker or taking low doses of these.

Question 3

A fictional patient takes the last dose of an ACE inhibitor on a Monday at 08:00. When is the earliest an Entresto tablet can be started?

Show the answer

Answer: From Tuesday evening, once at least 36 hours have passed

Working: 36 hours after Monday 08:00 is Tuesday 20:00, so the first Entresto tablet can be given from Tuesday evening. The product information requires a gap of at least 36 hours after stopping ACE inhibitor therapy.

eMC SmPC: Entresto 24 mg/26 mg, 49 mg/51 mg and 97 mg/103 mg film-coated tablets

https://www.medicines.org.uk/emc/product/7751/smpc

Where marks are lost

  • Doubling a 24 mg/26 mg start at 2 to 4 weeks when the product information gives doubling every 3 to 4 weeks for that group.
  • Starting Entresto within 36 hours of the last ACE inhibitor dose.
  • Doubling up after a missed dose instead of taking the next dose at the scheduled time.
  • Adding the two component strengths into one combined mg figure.

Frequently asked questions

Are these official assessment questions?

No. They are original revision exercises, not official GPhC questions and not for patient care.

Does this calculation decide a real dose?

No. Follow the stated prescription in the exercise. Real dosing follows the prescriber and the product information for the named product.

How should I check the answer?

Count the stated tablet strength twice for each component's daily total, then apply the doubling interval that matches the starting group.

Sources

The questions above are original and use fictional patients and prescriptions. PreRegExamPrep is not affiliated with or endorsed by the General Pharmaceutical Council.

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More calculation topics

See also the formula sheet, the eight sample questions and the approved calculator page.