A Guide to Entresto: How It’s Used for Heart Failure, Its Side Effects, and More

If you’re living with heart failure, you’re likely taking one or more medications to manage your condition. There’s a good chance your prescriber may suggest taking Entresto (sacubitril / valsartan). This combination medication is a first-choice treatment for many people with chronic heart failure.

If you’re just getting started with Entresto, it’s common to want to know more information about it. Whether you’re wondering how it works or what it’s used for, we’ve got you covered. Below is what you should know about Entresto and how it treats heart failure.

What is Entresto?

Entresto combines two medications:

1. Valsartan: Valsartan (available as a stand-alone medication called Diovan) is an angiotensin II receptor blocker (ARB). It’s commonly prescribed to treat heart conditions and hypertension (high blood pressure).

2. Sacubitril: Sacubitril is a neprilysin inhibitor. It’s the ingredient that makes Entresto different from other heart failure treatments.

Entresto dosage forms

Entresto comes as an oral tablet and sprinkle capsule in five doses (doses written as sacubitril / valsartan):

• 24 mg / 26 mg tablets

• 49 mg / 51 mg tablets

• 97 mg / 103 mg tablets

• 6 mg / 6 mg sprinkle capsules

• 15 mg / 16 mg sprinkle capsules

You should swallow Entresto tablets whole. If you have trouble swallowing pills, a pharmacist can create an oral liquid from the tablets. For Entresto sprinkle capsules, you can open the capsules and mix the contents with soft foods, such as applesauce.

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What is Entresto used for?

Entresto is a medication used to treat certain types of chronic heart failure in adults and children ages 1 and older. Entresto improves heart failure symptoms, such as shortness of breath, fatigue, and swelling. It can also help lower the risk of hospitalizations and death from the condition.

Depending on your health history, you may take Entresto with other heart failure medications. These could include:

• Beta blockers, such as metoprolol succinate (Toprol XL)

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as dapagliflozin (Farxiga)

• Diuretics (“water pills”), such as furosemide (Lasix)

What drug class is Entresto in?

Entresto is an angiotensin receptor-neprilysin inhibitor (ARNI). It combines valsartan (an ARB) with sacubitril (a neprilysin inhibitor). Entresto is the only medication in its class.

How does Entresto work?

Each active ingredient in Entresto works differently. Combined, they help manage heart failure better than valsartan does by itself.

The sacubitril in Entresto blocks the protein neprilysin. This action helps:

• Improve blood flow throughout the body, including to the heart and kidneys

• Raise levels of proteins in your body that protect the heart

• Improve your heart’s ability to pump blood

• Remove extra fluid from your bloodstream through your kidneys

• Protect the heart and prevent further damage

While sacubitril has many benefits, it can cause the protein angiotensin II to build up in your body. Angiotensin II plays a role in balancing blood pressure. But too much of it can cause your blood pressure to go up, potentially worsening heart failure.

The valsartan in Entresto helps offset this sacubitril side effect. Valsartan blocks the activity of angiotensin II. This helps lower blood pressure and protect your kidneys. Valsartan also helps prevent further heart damage.

Good to know: Valsartan (without sacubitril) is also a first-choice heart failure medication. But Entresto can improve health outcomes more than valsartan does on its own. It’s common for people to start with valsartan and then transition to Entresto.

What are the most common side effects of Entresto?

Entresto’s side effects are similar to those of ARBs and a group of similar medications called angiotensin-converting enzyme (ACE) inhibitors.

Examples of common Entresto side effects include:

• Mildly low blood pressure

• Dizziness and lightheadedness

• Mildly increased potassium levels

• Cough

Rare but serious Entresto side effects include:

• Severely low blood pressure

• Severely high potassium levels

• Angioedema (swelling of deep tissues)

• Kidney problems

• Harm to a fetus (if you take Entresto during pregnancy)

Entresto side effects could happen to anyone taking the medication. But older adults may be more sensitive to blood pressure changes, dizziness, and lightheadedness. This could raise your risk of falls. If you feel dizzy, find a place to sit or lie down until it passes. Tell your prescriber right away if you fall or faint while taking Entresto.

Before and during treatment with Entresto, your prescriber will likely ask you to go for blood tests to measure your potassium levels and kidney function. They should also monitor your blood pressure while you’re taking the medication. They may ask you to check your blood pressure at home too.

Which medications shouldn’t be taken with Entresto?

Entresto can be safely taken alongside many medications, but it does have several drug interactions. These include:

• ACE inhibitors, such as lisinopril (Zestril, Qbrelis)

• Other ARBs, such as losartan (Cozaar)

• Aliskiren (Tekturna)

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

• Potassium supplements

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

• Lithium (Lithobid)

Some of these Entresto interactions may need to be avoided completely. In other cases, your prescriber may just monitor for side effects that an interaction can cause.

What is the Entresto “washout period”?

The Entresto washout period is the time you need to wait if you’re switching from an ACE inhibitor to Entresto. These medication classes work similarly. And combining them can cause serious side effects, such as high potassium levels and angioedema.

Entresto has a washout period of 36 hours (1.5 days). This means you will need to stop taking an ACE inhibitor at least 36 hours before you start taking Entresto.

Who shouldn’t take Entresto?

Certain people may need to avoid Entresto, including people who:

• Have a history of angioedema that was related to an ACE inhibitor or ARB

• Have an allergy to Entresto or any of its ingredients

• Have severe liver disease

• Are pregnant or breastfeeding

• Take an ACE inhibitor or ARB

• Have diabetes and take aliskiren

There may be other reasons to avoid Entresto. So ask a healthcare professional about which heart failure medications are right for you.

How to save on Entresto

There are ways to save on Entresto, which is available as a brand-name and generic medication. GoodRx can help you navigate the ways you can save on your prescription.

• Save with GoodRx. GoodRx can help you save over 90% off the average retail price of the generic version of Entresto. For a 1-month supply, the price of sacubitril / valsartan at certain pharmacies is as low as $52.37 with a free GoodRx discount.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $10 per prescription for brand-name Entresto using a savings card from the manufacturer.

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Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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