Key takeaways:
Entresto (sacubitril / valsartan) is a prescription medication that treats heart failure. People often take it indefinitely. It’s usually not a good idea to stop taking it suddenly.
Stopping Entresto suddenly can worsen symptoms of heart failure, such as shortness of breath and fatigue. It can also increase the risk of heart failure complications and hospitalization.
Entresto has several drug interactions and side effects to be aware of. Your healthcare team can help you decide if Entresto is right for you or if something else would be better.
There are ways to save on brand-name and generic Entresto, such as using a free GoodRx discount or a manufacturer copay savings card.
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When your heart isn’t working at the top of its game, it may not be able to pump enough oxygen-filled blood throughout your body. This condition has an intimidating name: heart failure; but there are several ways to manage it.
Entresto (sacubitril / valsartan) is one option. It’s an oral medication that’s FDA approved to treat adults and children (ages 1 year and older) living with heart failure.
If your healthcare team recommends Entresto, it’s helpful to know a few facts about how to take it — and why taking it consistently is important. So, what happens if you suddenly stop taking Entresto? Here, you’ll learn answers to this and more.
1. Stopping Entresto suddenly isn’t usually a good idea
We don’t have a lot of research that shows what happens if you suddenly stop taking Entresto. But it’s possible that stopping Entresto could worsen heart failure.
Specifically, doing so could worsen left ventricular ejection fraction (LVEF). This is a measure of how well the heart works and how much blood it’s able to pump with each beat. A lower LVEF means the heart isn’t contracting as expected. So the rest of the body may not be receiving enough blood.
It’s possible your prescriber may recommend replacing Entresto with another heart failure medication at some point. In this case, they can help you safely transition medications so that your risk of side effects from stopping Entresto is lower.
Possible side effects of stopping Entresto treatment
Potential side effects of stopping Entresto (and not replacing it with another heart failure medication) include symptoms of worsening LVEF, such as shortness of breath, fatigue, and dizziness. So, in most cases, stopping Entresto suddenly without your prescriber’s approval isn’t a good idea.
One exception to this rule is angioedema. Angioedema refers to swelling of the deep tissues. This is a rare but serious side effect associated with Entresto. Symptoms include swelling of the face, neck, and mouth. In severe cases, it can lead to difficulty breathing and become life-threatening. If you think you’re having angioedema symptoms, stop taking the medication and seek emergency medical care right away. Once you’ve been treated, you can talk with your prescriber about whether another heart failure medication may be a better option for you.
Good to know: If you’ve been taking an angiotensin-converting enzyme (ACE) inhibitor, such as lisinopril (Zestril, Qbrelis), it’s important to have a “washout period” before starting Entresto. You’ll need to wait at least 36 hours (1.5 days) after stopping your ACE inhibitor before starting Entresto. This is done to help prevent side effects, such as angioedema, from happening. The same advice is true if you’re switching from Entresto to an ACE inhibitor.
2. You may need to take Entresto indefinitely
Most people need to take Entresto for a long time to reap the full benefits of the medication. If you’re wondering exactly how long to take Entresto, the answer is likely indefinitely — as long as you’re tolerating it well.
Research supports the idea that taking heart failure medication for a long time, and often indefinitely, is the best approach. Studies show that stopping treatment with these medications too early leads to worse outcomes, such as a higher risk of hospitalization and death related to heart failure. Some research shows that stopping treatment can also cause a reversal in any improvements to LVEF.
However, some people may need to stop taking Entresto. For example, if Entresto is causing other health issues, such as kidney damage, your prescriber may recommend stopping it. If your prescriber does recommend stopping treatment with Entresto, you don’t need to taper your dosage. Rather, you can just stop taking it. It’s likely that your prescriber will then recommend another heart failure medication to replace Entresto.
3. Entresto may start to lower blood pressure within a few hours, but its other heart benefits can take months
It takes about 2 hours for Entresto to start working after you take a dose. You may not feel differently, but you may experience a decrease in blood pressure levels. Though, the full benefits of Entresto take longer to materialize.
Here are summaries of study findings that look at how long Entresto takes to work:
Entresto lowers the amount of certain proteins that can make heart failure worse. The PROVE-HF study found that Entresto lowered participants’ protein levels within 2 weeks of starting the medication. They continued to improve throughout the 12-month (1-year) study.
Entresto helps improve the heart’s ability to pump blood efficiently. In the PROVE-HF study, participants’ LVEF was measured after 6 months and 12 months of treatment. The study found that the LVEF improved at both timeframes.
Entresto lowers the risk of hospitalization after 30 days of treatment. In the PARADIGM-HF study, which compared Entresto with the heart failure medication enalapril (Vasotec), Entresto lowered the risk of hospitalization due to heart failure within 30 days of treatment.
Good to know: Entresto reduces the risk of hospitalization and death related to heart failure in adults. While Entresto improves heart failure symptoms in children, research hasn’t shown yet that it lowers hospitalization and death in this group. In the PANORAMA-HF study, Entresto wasn’t any better than enalapril at treating heart failure in kids.
4. Entresto is most effective when taken twice a day
Entresto’s effects on the body start to lessen after several hours. This is why it’s usually taken twice a day. This helps make sure you consistently benefit from Entresto throughout the day.
Try to take Entresto around the same time each day. One possible strategy is taking it when you wake up in the morning and before you go to sleep. You can take Entresto with or without food.
5. Entresto is considered safe, but it’s a good idea to be aware of potential interactions and side effects
Entresto is generally considered safe and effective for treating heart failure in adults and children. But, as with all medications, Entresto has potential drug interactions and side effects to be aware of.
Entresto interactions
Avoid taking the following medications with Entresto:
ACE inhibitors, such as lisinopril or enalapril: Combining Entresto with these medications raises the risk of angioedema.
Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar): Entresto itself contains the ARB valsartan. Taking more than one ARB raises the risk of side effects.
Aliskiren (Tekturna) among people with diabetes or kidney disease: For people with these health conditions, combining aliskiren and Entresto increases the risk of further kidney damage.
This isn’t a comprehensive list of Entresto interactions. It’s best to share and maintain an updated list of your prescription and over-the-counter medications with your healthcare team. They can check if they interact with Entresto before you start the medication.
Entresto side effects
Many people tolerate Entresto without issue. But certain issues can still pop up. Common examples of Entresto side effects include:
Low blood pressure (hypotension)
High potassium levels
Cough
Dizziness
Kidney problems
Entresto can also cause angioedema in rare cases. So if you’ve experienced angioedema from an ACE inhibitor or ARB in the past, or you have hereditary angioedema (a rare genetic condition), you shouldn’t take Entresto.
Depending on your health history, Entresto may or may not be the best choice for you. Your prescriber can help you decide whether Entresto or another heart failure medication would be the best option.
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 get 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 receive brand-name Entresto for as little as $10 per prescription with a copay savings card from the manufacturer.
Frequently asked questions
If you miss a day of Entresto, you can get back on track with your regular schedule the next day. But don’t double up on your doses to make up for the missed one(s). Doing so raises your risk of experiencing more side effects, such as low blood pressure. There are medication reminder apps and other ways to jog your memory if you need help remembering to take Entresto.
In addition to Entresto, ACE inhibitors and ARBs are effective options for treating heart failure. They’re often taken in combination with other heart failure medications that work as a team to improve symptoms. Beta blockers such as carvedilol (Coreg) and aldosterone receptor blockers such as spironolactone (Aldactone) are a few examples. Dapagliflozin (Farxiga) is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that’s also an effective treatment option.
If you miss a day of Entresto, you can get back on track with your regular schedule the next day. But don’t double up on your doses to make up for the missed one(s). Doing so raises your risk of experiencing more side effects, such as low blood pressure. There are medication reminder apps and other ways to jog your memory if you need help remembering to take Entresto.
In addition to Entresto, ACE inhibitors and ARBs are effective options for treating heart failure. They’re often taken in combination with other heart failure medications that work as a team to improve symptoms. Beta blockers such as carvedilol (Coreg) and aldosterone receptor blockers such as spironolactone (Aldactone) are a few examples. Dapagliflozin (Farxiga) is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that’s also an effective treatment option.
The bottom line
Entresto (sacubitril / valsartan) is an oral medication that’s FDA approved for treating heart failure in children and adults. If you’re prescribed this medication, you might wonder what happens if you suddenly stop taking Entresto and how long you need to take it for. In most cases, Entresto is taken indefinitely. That’s because people who stop taking heart failure medication can experience negative outcomes, such as an increased risk of hospitalization and death. In the short-term, there’s also a potential for symptoms of worsening heart failure, such as shortness of breath, dizziness, and fatigue.
Don’t stop taking Entresto without talking to your prescriber first. They can help you decide if you need to stop treatment — perhaps because of kidney damage — and switch to another heart failure medication.
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References
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