Key takeaways:
Entresto (sacubitril / valsartan) is FDA approved to treat heart failure in adults and children ages 1 year and older. It’s taken by mouth twice daily.
Entresto is available in three different doses as an oral tablet. It also comes as sprinkle capsules and can even be prepared into an oral liquid at a pharmacy.
Talk to your cardiologist about your appropriate starting dosage and any necessary dose adjustments.
There are ways to save on Entresto. If you’re eligible, a manufacturer savings card can help you access brand-name Entresto for as little as $10 per month. GoodRx can also help you meaningfully save on the generic.
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Entresto (sacubitril / valsartan) is a first-choice medication for treating heart failure. What’s more, it’s FDA approved to treat two different forms of heart failure: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). It can help people with heart failure live longer and avoid hospitalizations.
Entresto, which is the only available angiotensin receptor neprilysin inhibitor (ARNI) medication, is a type of combination treatment. It contains sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker (ARB). Entresto’s dosages are based on how much medication one tablet contains, with sacubitril listed first and valsartan listed second.
This Entresto dosage guide provides general recommendations about approved Entresto dosages. But you should always speak with your cardiologist about the Entresto dosage that’s right for you.
What’s the typical Entresto dosage for adults?
Entresto is an oral tablet that comes in three doses: 24 mg/26 mg, 49 mg/51 mg, and 97 mg/103 mg of sacubitril/valsartan. It’s recommended to take it twice daily.
The typical starting Entresto dosage for adults is 49 mg/51 mg twice daily. Your cardiologist will track your response to this dose, and if tolerated, adjust it to the higher 97 mg/103 mg twice daily dosage. This higher dose is the target maintenance dosage. This adjustment usually happens 2 to 4 weeks after starting the medication, based on how well it’s tolerated and how well it’s working.
What’s the typical Entresto dosage for children?
Entresto is also approved to treat heart failure in kids who are at least 1 year old. It’s still taken twice daily, but the right Entresto dose will depend on your child’s body weight.
In most cases, your child’s dose will slowly go up as their body gets used to the medication. The starting dose is typically taken for 2 weeks. If tolerated, it can be adjusted to the “second step” dosage listed below. After another 2 weeks at this middle dose, it can be adjusted again to the target maintenance dose.
Body weight | Starting dose* | Second step dose* | Target maintenance dose* |
Less than 40 kg (88 lb) | 1.6 mg of combined sacubitril and valsartan per kg | 2.3 mg of combined sacubitril and valsartan per kg | 3.1 mg of combined sacubitril and valsartan per kg |
Between 40 kg and 50 kg (110 lb) | 24/26 mg | 49/51 mg | 72/78 mg |
More than 50 kg | 49/51 mg | 72/78 mg | 97/103 mg |
*Taken twice daily
If your child has trouble swallowing tablets, you have other options. Entresto is also available as Entresto Sprinkle, which may be easier for some children to take. These capsules contain small pellets. Instead of swallowing the capsules whole, you’ll open them and sprinkle the pellets onto a small amount of soft food, such as applesauce or yogurt.
Entresto Sprinkle comes in two doses: 6 mg/6 mg and 15 mg/16 mg. These lower-dose options can make it easier to match your child’s dose to their body weight. If your child weighs less than 50 kg and is starting Entresto Sprinkle for the first time, their prescriber should slowly increase the dose over time until they reach the right maintenance dose.
If Entresto Sprinkle isn’t an option, a pharmacist can prepare a liquid (oral suspension) from Entresto tablets for certain children. This liquid should only be made by a pharmacy — not at home. Once prepared, it can be stored at room temperature for up to 15 days.
Are there any Entresto dosage adjustments for medical conditions?
Possibly. Your dose might be different if you have certain medical conditions. If you have kidney or liver problems, your cardiologist may consider a lower Entresto dose.
Your cardiologist may also reduce the starting dose if you’re not currently taking an ARB, like losartan (Cozaar), or an angiotensin-converting enzyme (ACE) inhibitor, like lisinopril (Zestril), before switching to Entresto. This is also the case if you were previously taking a low dose of an ARB or ACE inhibitor. Taking either of these medications builds a tolerance to Entresto, which makes it more likely that you can tolerate Entresto at the typical starting dose.
Keep in mind: You should not take an ARB or ACE inhibitor and Entresto together. It’s important to safely switch over with the help of your cardiologist.
What happens if you miss a dose of Entresto?
It’s important to take Entresto regularly as it’s prescribed. But missed doses can sometimes happen. If you miss a dose of Entresto, take it as soon as you remember.
But if it’s almost time for your next dose, don’t take your missed dose. Instead, take the next dose at the usual time. You don’t want to double up on doses too close together. This can lead to too much medication in your body.
What should you do if you take too much Entresto?
If you take too much Entresto, don’t panic. In limited reports, single high doses haven’t been linked to serious effects.
However, taking too much Entresto can still raise the risk of serious side effects. Possible complications include:
Very low blood pressure
Dizziness or lightheadedness that could lead to a fall
Very high potassium levels
Worsened kidney problems
If you or someone you know took too much Entresto, contact your cardiologist or call Poison Control at 1-800-222-1222. This is a good precaution to take even if you’re feeling normal. But if you’re experiencing symptoms that feel worrisome or severe, call 911 or go to the nearest ER right away.
How to save on Entresto
There are ways to save on Entresto, which is available as a brand-name medication and lower-cost generic.
Save with GoodRx: Using a free GoodRx discount, you can purchase a 1-month supply of generic Entresto for as low as $52.37 at certain pharmacies.
Use a manufacturer savings card. If you have commercial insurance, you may be eligible to fill brand-name Entresto for as little as $10 per prescription with a copay savings card from the manufacturer.
Frequently asked questions
You shouldn’t crush Entresto unless your prescriber or pharmacist tells you it’s safe to do so. Altering the tablets on your own can change how the medication is absorbed and may affect how well it works.
Entresto is designed to be taken twice a day, about 12 hours apart. Taking it once daily would likely leave you without enough medication in your system for part of the day, which would make it less effective at managing heart failure.
If remembering your second daily dose is difficult, ask your prescriber about strategies such as phone reminders, pill organizers, or adjusting the timing (while still taking it twice daily). Don’t switch to once-daily dosages unless your cardiologist specifically instructs you to do so.
Taking a double dose of Entresto by mistake can raise your risk of side effects, such as dizziness, high potassium levels, or kidney problems.
If this happens, sit or lie down if you feel lightheaded. Avoid driving or getting up too quickly. Call your prescriber or pharmacist as soon as possible for guidance — especially if you have symptoms like weakness, chest discomfort, or trouble breathing. Get emergency medical care right away if you faint, have chest pain, severe shortness of breath, or other serious symptoms.
You shouldn’t crush Entresto unless your prescriber or pharmacist tells you it’s safe to do so. Altering the tablets on your own can change how the medication is absorbed and may affect how well it works.
Entresto is designed to be taken twice a day, about 12 hours apart. Taking it once daily would likely leave you without enough medication in your system for part of the day, which would make it less effective at managing heart failure.
If remembering your second daily dose is difficult, ask your prescriber about strategies such as phone reminders, pill organizers, or adjusting the timing (while still taking it twice daily). Don’t switch to once-daily dosages unless your cardiologist specifically instructs you to do so.
Taking a double dose of Entresto by mistake can raise your risk of side effects, such as dizziness, high potassium levels, or kidney problems.
If this happens, sit or lie down if you feel lightheaded. Avoid driving or getting up too quickly. Call your prescriber or pharmacist as soon as possible for guidance — especially if you have symptoms like weakness, chest discomfort, or trouble breathing. Get emergency medical care right away if you faint, have chest pain, severe shortness of breath, or other serious symptoms.
The bottom line
Most adults take Entresto (sacubitril / valsartan) at a starting dosage of 1 tablet (49 mg/51 mg) twice daily. Those with kidney problems, liver problems, or those who haven’t taken an ARB or angiotensin-converting enzyme (ACE) inhibitor before may start with a lower dose. After a few weeks, the dose can be adjusted by your cardiologist to the target dose based on how well you tolerate it. Children’s Entresto dosages are based on body weight.
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References
Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation.
Novartis. (2025). Entresto sacubitril and valsartan pellet [package insert]. DailyMed.
Novartis. (2025). Entresto sacubitril and valsartan tablet, film coated [package insert]. DailyMed.
