CIDMUS TABLETS is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal.

LVEF is a variable measure, so use clinical judgment in deciding whom to treat.

Adults:

• Heart Failure :The recommended starting dose of CIDMUS is 49/51 (100mg) mg orally twice-daily. ¨ Double the dose of CIDMUS after 2 to 4 weeks to the target maintenance dose of 97/103 (200mg) mg twice daily, as tolerated by the patient. ¨In patients not currently taking an ACE inhibitor or an angiotensin II receptor blocker (ARB) and for patients previously taking low doses of these agents, start CIDMUS at half the usually recommended starting dose. ¨After initiation, increase the dose every 2 to 4 weeks in adults. .
• Pediatric patients: CIDMUS has not been studied. Use of CIDMUS is not recommended.
• Geriatric patients: No dosage adjustment is required.
• Renal impairment: No starting dose adjustment is required in patients with mild to moderate renal impairment; In adult patients with severe renal impairment (eGFR < 30 mL/min/1.73 m2), start CIDMUS at half the usually recommended starting dose. After initiation, increase the dose to follow the recommended dose escalation thereafter.
• Hepatic impairment: No starting dose adjustment is required in patients with mild hepatic impairment. In adults patients with moderate hepatic impairment (Child-Pugh B classification), start CIDMUS at half the usually recommended starting dose. After initiation, increase the dose to follow the recommended dose escalation thereafter.  .Use in patients with severe hepatic impairment is not recommended.

Method of adminstration:
For oral use. May be administered with or without food.

• In patients with hypersensitivity to any component.
• In patients with a history of angioedema related to previous ACE inhibitor or ARB therapy.
• With concomitant use of ACE inhibitors. Do not administer within 36 hours of switching from or to an ACE inhibitor.
• With concomitant use of aliskiren in patients with diabetes.

Pregnancy: CIDMUS must not be used during pregnancy. Patients should be advised to discontinue CIDMUS as soon as pregnancies occur and to inform their physicians.

Lactation: It is not known whether CIDMUS is transferred into human milk. Because of the potential risk for adverse drug reactions in breastfed newborns/infants, CIDMUS is not recommended during breast-feeding.

Females and males of reproductive potential: Female patients of childbearing potential should be advised about the consequences of exposure to CIDMUS during pregnancy and to use contraception during treatment and for 1 week after their last dose of CIDMUS.

Dual Blockade of the Renin-Angiotensin-Aldosterone System: Avoid using CIDMUS TABLETS with ACE inhibitors as it increases the risk of angioedema. Do not use CIDMUS TABLETS with ARBs because it contains valsartan. CIDMUS TABLETS should not be used with aliskiren in patients with diabetes or in those with renal impairment (eGFR < 60 mL/min/1.73 m²).

Potassium-Sparing Diuretics: Using CIDMUS TABLETS with potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, or potassium-containing salt substitutes may raise potassium levels.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): In elderly patients, those who are volume-depleted, or with impaired kidney function, using NSAIDs or COX-2 inhibitors with CIDMUS TABLETS may worsen kidney function, including causing acute renal failure. These effects are typically reversible, so monitor kidney function regularly.

Lithium: Concomitant use of lithium and CIDMUS TABLETS may increase lithium levels and cause toxicity. Therefore, monitor lithium levels during combined use.