Farxiga vs. Entresto: 6 Differences Between These Heart Failure Medications

If you’re living with heart failure, there’s a good chance you’re taking one or more medications for it. And in the recent past, the number of heart failure treatments has expanded. This has provided more options for a historically hard-to-treat health condition.

Farxiga (dapagliflozin) and Entresto (sacubitril / valsartan) are some of the newer heart failure medications available. From advertisements on TV and in cardiologists’ (heart doctors’) offices, these two medication names have become well known. Both can help lower your risk of complications and death related to heart failure.

But there are several facts to keep in mind when comparing Farxiga versus Entresto. Here, we’ll cover six notable differences and why your prescriber may choose one over the other.

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1. Farxiga and Entresto belong to different medication classes

One of the biggest differences between Farxiga and Entresto is that they belong to different medication classes.

Farxiga is a sodium-glucose cotransporter-2 (SGLT2) inhibitor. SGLT2 inhibitors are used to treat a few health conditions besides heart failure. In fact, Farxiga was originally FDA approved to treat Type 2 diabetes. Further research showed it was also helpful for treating heart failure and chronic kidney disease.

Entresto combines two medications into one tablet: sacubitril and valsartan. It’s an angiotensin receptor neprilysin inhibitor, also called an ARNI. Entresto is the only medication in its class.

Good to know: One of Entresto’s components, valsartan, is available by itself (sold under the brand name Diovan). It’s often prescribed to help lower blood pressure. But it’s also a common heart failure medication.

2. Farxiga and Entresto work differently

Farxiga and Entresto work differently from each other.

Experts aren’t clear on all the ways Farxiga works for heart failure. But we know it does the following:

• It prevents the kidneys from reabsorbing sodium (salt) and glucose (sugar) into the bloodstream.

• It lowers the amount of fluid in the bloodstream, taking stress off the heart and kidneys.

• It lowers blood pressure.

• It may lower levels of inflammation in and around the heart.

• It may help prevent the heart from changing shape over time.

• It may improve energy usage in the heart, helping it pump blood more effectively.

The two medications in Entresto work together and have the following effects:

• It improves blood flow throughout your body.

• It lowers your blood pressure.

• It protects your heart and kidneys against damage.

• It helps your kidneys remove extra fluid more efficiently, taking stress off your heart.

• It increases levels of certain proteins that help protect your heart health.

3. Entresto is FDA approved for children and adults, but Farxiga is approved only for adults

Entresto has been studied and is FDA approved for treating heart failure in children. In fact, it can be prescribed to children as young as 1 year old.

Farxiga is FDA approved only for use in adults 18 years and older. There isn’t enough data to know if it’s safe and effective for children.

4. The recommended dosages for Farxiga and Entresto are different

When taken for heart failure, the recommended Farxiga dosage is 10 mg (one tablet) once a day in the morning. As we’ll discuss, Farxiga makes you urinate more often. Taking it in the morning can help stop you from getting up to go in the middle of the night.

Entresto is an oral tablet that comes in three doses:

• 24 mg sacubitril / 26 mg valsartan

• 49 mg sacubitril / 51 mg valsartan

• 97 mg sacubitril / 103 mg valsartan

Most people start with the lowest dose of Entresto and take one tablet twice a day. Your dose will likely be raised over the first few weeks you take it. The recommended maintenance (long-term) dosage of Entresto is 97 mg/103 mg twice a day.

5. Farxiga and Entresto have different side effects

Farxiga and Entresto also differ in what side effects they typically cause.

Because of how Farxiga works, it causes you to get rid of extra glucose in your urine. But bacteria and fungi are attracted to glucose. This raises your risk of developing urinary tract infections (UTIs) and fungal (“yeast”) infections of the genitals.

Other possible Farxiga side effects include:

• Urinating more often, especially in the hours after taking it

• Weight loss

• Cold-like symptoms

• Back pain

• Nausea

• Constipation

• Low blood glucose (hypoglycemia)

• Dehydration — a rare but serious side effect

• Serious genital infections — a rare but serious side effect

• Ketoacidosis (too much acid in the blood) — a rare but serious side effect

Entresto doesn’t affect glucose levels or how much you urinate. It also doesn’t raise the risk of UTIs or yeast infections. But it can cause the following side effects:

• Blood pressure that’s too low (hypotension)

• Dizziness

• Cough

• High potassium levels

• Kidney damage — a rare but serious side effect

• Swelling of deep tissues (angioedema) — a rare but serious side effect

• Birth defects if taken during pregnancy

6. Farxiga and Entresto have distinct interactions

Drug interactions are another notable difference between Farxiga and Entresto. They generally interact with separate medications. Be sure to share a medication list with your prescriber and pharmacist. This will help them manage or prevent interactions before they become a problem.

Key Farxiga interactions include:

• Diuretics (water pills), such as hydrochlorothiazide or furosemide (Lasix)

• Insulin

• Sulfonylureas, such as glipizide (Glucotrol XL) or glyburide (DiaBeta, Glynase)

• Glinides, such as repaglinide

• Lithium (Lithobid) — Farxiga may lower lithium levels

Notable Entresto interactions include:

• Angiotensin-converting enzyme inhibitors, such as lisinopril (Zestril)

• Other angiotensin II receptor blockers, such as losartan (Cozaar)

• Aliskiren (Tekturna)

• Medications that raise potassium levels, such as spironolactone (Aldactone)

• Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin)

• Lithium — Entresto may raise lithium levels

How does a prescriber choose between Farxiga and Entresto?

There are several reasons your cardiologist may prescribe either Farxiga or Entresto, including:

• Other health conditions: Farxiga is also FDA approved to treat Type 2 diabetes and chronic kidney disease. If you have either of these health conditions, your prescriber may favor Farxiga, since it can help with all three.

• Already taking valsartan: Entresto contains valsartan. If you’re already taking it for heart failure, your prescriber may suggest switching to Entresto. This is a common strategy for treating heart failure, since many people with the condition start treatment with valsartan.

• Your age: If you are under 18, your prescriber will likely choose Entresto. This is because it’s more well studied in children with heart failure.

• Weight-loss goals: If weight loss is one of your health goals, your prescriber may prefer Farxiga. This medication can promote modest weight loss for some people. Farxiga isn’t considered a weight-loss medication, though.

• Potential side effects: Some people are more prone to or at a higher risk for certain side effects, such as yeast infections or angioedema. If this is the case for you, your prescriber may choose a medication to help you avoid certain side effects.

• Drug interactions: As discussed above, Farxiga and Entresto have unique interactions. Your prescriber may choose one of them based on what other medications you’re already taking.

• Insurance coverage: Your insurance plan may not cover one of these medications. Your prescriber may pick Farxiga or Entresto based on whether it’s covered by your plan.

Can you take both Farxiga and Entresto for heart failure?

Yes, you can take both Farxiga and Entresto if needed. They don’t interact with each other. And there’s some evidence that combining Entresto with an SGLT2 inhibitor, such as Farxiga, may provide added benefit.

Keep in mind that this strategy isn’t right for everyone with heart failure. Your cardiology care team will help determine if it’s appropriate for you to take both Farxiga and Entresto.

How to save on Farxiga and Entresto

There are ways to save on Farxiga and Entresto. Both are available as brand-name medications. But you can also find Farxiga as an authorized generic. GoodRx can help you navigate ways to save on your prescription.

• Save with a free trial. Entresto’s manufacturer offers a free 30-day trial of the medication. You can use this free trial even if you don’t have insurance.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, brand-name Farxiga’s price is as little as $0 per month using a copay savings card from the manufacturer. And Entresto’s price may be as low as $10 per prescription with a manufacturer savings card.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Farxiga’s and Entresto’s patient assistance programs, which offer the medication for free.

• Save with GoodRx. GoodRx can help you save over 50% off the average retail price of dapagliflozin (the generic version of Farxiga). Generic dapagliflozin’s price at certain pharmacies may be as low as $332.55 with a free GoodRx discount.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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