Key takeaways:
Entresto (sacubitril / valsartan) is a prescription medication that treats heart failure. The most common Entresto side effect is low blood pressure, which can cause dizziness. Other possible side effects include cough and increased potassium levels.
More severe Entresto side effects, such as very low blood pressure, high potassium levels, and kidney problems, are rare but possible.
Having certain health conditions or taking certain medications can increase your risk of side effects from Entresto. Give your healthcare team your full medical history and updated medication list before starting Entresto.
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Entresto (sacubitril / valsartan) has been hailed as a “game changer” medication for treating heart failure since its initial FDA approval in 2015. That’s because it was the first medication of its kind: a combination of an angiotensin II receptor blocker (valsartan) and neprilysin inhibitor (sacubitril).
Fast forward a decade later, Entresto is still a first-choice medication for treating heart failure. But like nearly all medications, side effects are possible.
Entresto side effects at a glance
Entresto is generally well tolerated. But possible Entresto side effects include:
Cough
Low red blood cell levels
Entresto can also lead to more serious risks in rare cases, such as:
Severely low blood pressure
Severely high potassium levels
Kidney problems
Severe allergic reactions that can cause swelling of the lips, throat, and deep tissues (angioedema)
This medication also has a boxed warning for birth defects if taken during pregnancy. A boxed warning is the FDA’s strictest warning for medications.
Before starting Entresto, make sure your healthcare professional knows your full health history and other medications you take. This will help them decide whether Entresto is right for you.
Here, we’ll take a closer look at five Entresto side effects and how to manage them.
1. Low blood pressure
Hypotension (low blood pressure) is the most commonly reported Entresto side effect. This side effect isn’t surprising, though. Valsartan, one of the active ingredients in Entresto, is prescribed to lower blood pressure on its own. It’s part of a group of medications called ARBs. These medications are prescribed for hypertension (high blood pressure), heart failure, and more.
Certain factors can increase your risk of low blood pressure while taking Entresto. This includes older age, having low blood pressure prior to starting Entresto, and taking other medications that lower blood pressure.
Symptoms of low blood pressure include feeling dizzy, lightheaded, or weak. Let your healthcare team know if you experience any of these symptoms. They may recommend lowering your Entresto dosage or the dosage of other medications you take. But don’t make any changes without talking to your prescriber first.
2. High potassium levels
Hyperkalemia (high potassium levels) is another possible Entresto side effect. Potassium is a mineral you get from food, and it plays an essential role in many bodily functions. For example, potassium helps your heart work efficiently and regulates blood pressure.
Entresto basics: Learn how Entresto works and what type of heart failure it treats.
Generic Entresto: As of 2025, Entresto is now available as a generic. Here’s what to know about it.
Taking Entresto: The typical Entresto dosage is 1 tablet twice daily, but certain factors may impact how much you should take.
Some people have a higher risk of developing hyperkalemia from Entresto. This includes people who:
Have certain health conditions, such as diabetes, kidney damage, or low aldosterone (hypoaldosteronism)
Consume a diet that's high in potassium
Take other medications that can increase potassium levels, including spironolactone (Aldactone) or potassium supplements
Symptoms of high potassium may include nausea, muscle weakness, and fatigue. But high potassium often doesn’t cause symptoms until it becomes very high (6 mEq/L or more). Very high potassium levels can cause arrhythmia (irregular heartbeat) and be life-threatening.
Your healthcare team will likely monitor your potassium levels with a blood test before and during treatment with Entresto. If your potassium levels increase, your prescriber may lower your Entresto dosage. Or they may recommend switching to another medication altogether.
3. Cough
Developing a dry cough is another possible Entresto side effect. This is due to the valsartan component of the medication. All ARBs, including valsartan, may cause a dry, hacking cough.
This side effect is much less common with ARBs than it is with angiotensin-converting enzyme (ACE) inhibitors, though. These are another group of common blood pressure medications. For example, in a major study that led to Entresto’s FDA approval, cough was more common with the ACE inhibitor enalapril (Vasotec, Epaned) than it was with Entresto.
Let your healthcare team know if you develop a dry cough that doesn’t go away while you’re taking Entresto. They can help you figure out if this is due to Entresto, or related to something else.
4. Kidney problems
ARBs like valsartan help protect the kidneys in many cases. But in rare cases, Entresto may cause worsening kidney function or even sudden kidney failure.
Because kidney problems are possible with Entresto, it’s important to recognize the warning signs. Watch for symptoms such as:
Producing little or no urine
Swelling in your ankles or lower legs
Tiredness
Feeling short of breath
Confusion
Nausea
If you have existing kidney problems, you may be at higher risk for kidney-related side effects from Entresto. So be sure your healthcare team knows your complete medical history. And let them know what other medications you take as well. Taking certain medications with Entresto can increase your risk of kidney damage. This includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin).
If you take Entresto, your prescriber should order lab tests (such as a creatinine blood test) to check your kidney function before and after starting treatment. If your kidney function is already lower than expected, they may start you at a lower Entresto dosage. If your kidney function worsens after starting this medication, you may need to lower your dose or switch to another medication entirely.
5. Angioedema
Angioedema is a rare but serious risk with Entresto. It typically appears in areas of the face, like the lips when it happens. It can also occur in the throat and neck. In severe cases, it can cause trouble breathing that’s life-threatening.
In one study, Black people were more likely to experience angioedema from Entresto. You’re also at increased risk if you’ve experienced angioedema in the past. So Entresto isn’t recommended if you’ve ever had angioedema (even if it was from another medication, such as an ACE inhibitor).
If you experience swelling of your face, lips, tongue, or throat, or trouble breathing while taking Entresto, stop taking it and call 911 or go to the nearest ER. Most cases of angioedema resolve on their own, but if you develop trouble breathing, you’ll need immediate medical care.
Frequently asked questions
Yes, heart medications like Entresto can cause dizziness. Entresto can lower your blood pressure, and low blood pressure can cause dizziness in turn.
You should avoid certain medications, such as NSAIDs like ibuprofen, while taking Entresto. You should also avoid becoming pregnant because Entresto can cause harm to a fetus. Avoid excess alcohol intake, too, since it can further lower your blood pressure. You may also need to stand up slowly from sitting or lying down positions to prevent a sudden drop in your blood pressure. A drop could cause dizziness or a fall.
You’ll likely take Entresto long-term, even indefinitely, to treat heart failure. Don’t stop taking Entresto suddenly, as stopping it can worsen heart failure symptoms.
There are a few situations where Entresto isn’t recommended. This includes people who:
Have an allergy to Entresto
Have a history of angioedema
Take an ARB or ACE inhibitor
Have diabetes and take aliskiren (Tekturna)
Are pregnant or breastfeeding
Whose blood pressure is too low
Have severe liver problems
Can’t reliably obtain or afford Entresto, which may lead to inconsistent use
How long you can live with heart failure depends on many factors, including your age and other health conditions you have. It also depends on how well your heart failure is treated. Using a recommended combination of medications can help you live longer and significantly improve your quality of life. Heart-healthy lifestyle choices are also very important, such as quitting smoking, following a heart-healthy diet, and managing sleep apnea if you have it.
Most people will take a combination of medications to treat heart failure, which may or may not include Entresto. While there is no direct alternative to Entresto, a generic form of Entresto is available. Medications other than Entresto that treat heart failure include:
ARBs, such as losartan (Cozaar)
ACE inhibitors, such as lisinopril (Zestril)
Beta blockers, such as carvedilol (Coreg)
Diuretics (water pills), such as furosemide (Lasix)
Aldosterone blockers, such as spironolactone (Aldactone)
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin (Jardiance)
No, Entresto isn’t a blood thinner. Entresto contains two active ingredients, valsartan and sacubitril. Neither of these medications are blood thinners.
While blood thinners aren’t typically used to treat heart failure itself, you may benefit from one if you have other heart conditions, such as atrial fibrillation. Blood thinner medications (called anticoagulants) include apixaban (Eliquis), rivaroxaban (Xarelto), and warfarin (Coumadin, Jantoven).
Yes, heart medications like Entresto can cause dizziness. Entresto can lower your blood pressure, and low blood pressure can cause dizziness in turn.
You should avoid certain medications, such as NSAIDs like ibuprofen, while taking Entresto. You should also avoid becoming pregnant because Entresto can cause harm to a fetus. Avoid excess alcohol intake, too, since it can further lower your blood pressure. You may also need to stand up slowly from sitting or lying down positions to prevent a sudden drop in your blood pressure. A drop could cause dizziness or a fall.
You’ll likely take Entresto long-term, even indefinitely, to treat heart failure. Don’t stop taking Entresto suddenly, as stopping it can worsen heart failure symptoms.
There are a few situations where Entresto isn’t recommended. This includes people who:
Have an allergy to Entresto
Have a history of angioedema
Take an ARB or ACE inhibitor
Have diabetes and take aliskiren (Tekturna)
Are pregnant or breastfeeding
Whose blood pressure is too low
Have severe liver problems
Can’t reliably obtain or afford Entresto, which may lead to inconsistent use
How long you can live with heart failure depends on many factors, including your age and other health conditions you have. It also depends on how well your heart failure is treated. Using a recommended combination of medications can help you live longer and significantly improve your quality of life. Heart-healthy lifestyle choices are also very important, such as quitting smoking, following a heart-healthy diet, and managing sleep apnea if you have it.
Most people will take a combination of medications to treat heart failure, which may or may not include Entresto. While there is no direct alternative to Entresto, a generic form of Entresto is available. Medications other than Entresto that treat heart failure include:
ARBs, such as losartan (Cozaar)
ACE inhibitors, such as lisinopril (Zestril)
Beta blockers, such as carvedilol (Coreg)
Diuretics (water pills), such as furosemide (Lasix)
Aldosterone blockers, such as spironolactone (Aldactone)
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin (Jardiance)
No, Entresto isn’t a blood thinner. Entresto contains two active ingredients, valsartan and sacubitril. Neither of these medications are blood thinners.
While blood thinners aren’t typically used to treat heart failure itself, you may benefit from one if you have other heart conditions, such as atrial fibrillation. Blood thinner medications (called anticoagulants) include apixaban (Eliquis), rivaroxaban (Xarelto), and warfarin (Coumadin, Jantoven).
The bottom line
Entresto is a medication that treats heart failure. It contains two active ingredients: valsartan and sacubitril. Entresto is generally well tolerated, but side effects are still possible, so it helps to know what to watch out for. The most common Entresto side effect is low blood pressure, which can lead to dizziness. High potassium levels (hyperkalemia), kidney problems, and angioedema (swelling of deep tissues) are rare but can also occur.
Before starting Entresto, make sure your healthcare team knows your full health history and other medications you take. This will help them decide whether Entresto is the right option for you.
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References
American Heart Association. (2025). Medications used to treat heart failure.
Heidenrich, P. A., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation.
McMurray, J. J. V., et al. (2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. The New England Journal of Medicine.
Memon, R. J., et al. (2023). Angioedema. StatPearls.
Mukherjee, S. (2015). Novartis set to redraw the heart failure map with rapid approval of game-changer Entresto. BioPharma Dive.
Novartis Pharmaceuticals. (2025). Entresto - sacubitril and valsartan tablet, film coated; Entresto- sacubitril and valsartan pellet [package insert]. DailyMed.
Tomson, C. R. V., et al. (2021). Management of blood pressure in patients with chronic kidney disease not receiving dialysis: Synopsis of the 2021 KDIGO clinical practice guideline. Annals of Internal Medicine.
Vardeny, O., et al. (2018). Incidence, predictors, and outcomes associated with hypotensive episodes among heart failure patients receiving sacubitril/valsartan or enalapril: The PARADIGM-HF trial (prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin-converting enzyme inhibitor to determine impact on global mortality and morbidity in heart failure). Circulation: Heart Failure.
