In which condition is the administration of sacubitril/valsartan contraindicated?

The administration of sacubitril/valsartan is contraindicated in end-stage liver failure primarily due to the significant effects this combination drug can have on the liver. Sacubitril/valsartan functions as an angiotensin receptor neprilysin inhibitor (ARNI) and is metabolized by the liver. In cases of severe liver impairment, the metabolism and clearance of the drug can be greatly reduced, leading to increased plasma levels and a higher risk of adverse effects, such as hypotension, renal impairment, or electrolyte imbalances.

In contrast, diabetes, hypertension, and atrial fibrillation do not present the same level of contraindication. While patients with these conditions may require careful monitoring and dosage adjustments when using sacubitril/valsartan, they do not face the same inherent risks associated with severe liver dysfunction. Thus, end-stage liver failure is the critical factor that defines the contraindication for this medication, emphasizing the need to assess liver function before prescribing this therapy.