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Psychiatric Manifestations With Sacubitril/Valsartan: A Case Report
Jessica Wooster1, Elizabeth A Cook1, Denver Shipman1
1University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, TX, USA.
Insights
Sacubitril/valsartan, a heart failure medication, may cause psychiatric side effects like paranoia and hallucinations. Discontinuation of the drug led to symptom resolution in a patient with heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Neuroscience
- Pharmacology
Background:
- Sacubitril/valsartan is an established treatment for heart failure with reduced ejection fraction (HFrEF).
- While valsartan is well-characterized, the neurocognitive effects of sacubitril, the neprilysin inhibitor component, require further investigation.
- Understanding potential adverse effects is crucial for patient safety and optimizing therapy.
Observation:
- A 31-year-old African American female with HFrEF experienced acute psychiatric symptoms including paranoia, delusions, and hallucinations after a sacubitril/valsartan dose increase.
- The patient had no prior psychiatric history; symptoms emerged over 7 days.
- Cranial CT revealed intracranial volume loss and mild ventricular enlargement, abnormal for age.
Findings:
- Psychiatric symptoms resolved upon discontinuation of sacubitril/valsartan, indicating medication intolerance.
- Laboratory tests and toxicology screens were negative, excluding infectious or substance-induced causes.
- The observed neurological changes suggest a potential link between sacubitril/valsartan and central nervous system effects.
Implications:
- This case highlights the potential for sacubitril/valsartan to induce psychiatric adverse effects, necessitating careful monitoring.
- Further research into neprilysin inhibition's role in cognitive function is warranted.
- Clinicians should consider psychiatric evaluation in HFrEF patients experiencing new-onset neurological or behavioral changes while on sacubitril/valsartan.
Abstract:
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor approved for the treatment of heart failure with reduced ejection fraction (HFrEF). Valsartan is well studied, but sacubitril has much left to understand. This report describes a 31-year-old African American female diagnosed with HFrEF who presented with a 7-day history of psychiatric symptoms following a dose increase in sacubitril/valsartan. Prior to the dose increase, the patient had no history of psychiatric diagnoses, but upon hospital presentation, family described instances of confabulation, paranoia, delusions, hallucinations, and sleep disturbances. Laboratory tests were unremarkable, ruling out infectious processes and illicit substance use. However, cranial computed tomography scans depicted intracranial volume loss abnormal for age with commensurate mild ventricular enlargement. Sacubitril/valsartan was discontinued inpatient, symptoms resolved, and the medication intolerance was documented. Clinical trials involving sacubitril/valsartan lack systematic documentation of cognitive symptoms, but active studies exploring the role of neprilysin inhibition may expand knowledge of possible psychiatric adverse effects.
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