Abstract
Objective Drug induced myoclonus has been identified in number of medication classes. We describe a case of drug induced myoclonus from a newly marketed novel combination medication angiotensin receptor-neprilysin inhibitor Sacubitril/Valsartan (Entresto®), indicated for heart failure.
Methods A case report.
Results A 75 year old independent male presented with 11 hours of head and upper limb sudden onset myoclonic activity on the background of known history of heart failure having commenced Sacubitril/Valsartan one month prior and recently dose escalated. There was no inter-current illnesses and no other drug changes. Examination revealed an involuntary, irregular intermittent myoclonic activity in bilateral arms and head. Vital signs were normal. There was no acute abnormality on CT Brain or baseline blood tests. EEG showed marginal slowing in the right central region and no electrical correlate for the myoclonus. Following cessation of the Sacubitril/Valsartan the patient’s myclonus abated within 36 hours and the patient was discharged home with no further complication.
Conclusion Myoclonus and other involuntary movements have been reported with the use of Sacubitril/Valsartan with onset ranging from hours to days in patients with similar medical profiles.1 Similar side effects have been seen in rodent models but not in primates, and no clear pharmacological mechanism exists at this stage. We present this case to inform other clinicians of the potential serious neurological side effect of this increasingly used medication.
Reference
Bejan-Angoulvant T, Genet T, Vrignaud L, Angoulvant D, Fauchier L. Three case reports of involuntary muscular movements as adverse reactions to sacubitril/valsartan. Br J Clin Pharmacol. 2018;84(5):1072–1074.
