Entresto
Entresto (sacubitril / valsartan) is an angiotensin receptor-neprilysin inhibitor (ARNI). It's a combination medication that's approved to treat heart failure in adults and children ages 1 year and older. Entresto (sacubitril / valsartan) is available as tablets or pellets taken by mouth twice a day. Some side effects of this medication include a lower blood pressure, cough, and dizziness. Entresto (sacubitril / valsartan) isn't available as a generic.
What is Entresto (sacubitril / valsartan)?
What is Entresto (sacubitril / valsartan) used for?
Heart failure in people ages 1 year or older
How Entresto (sacubitril / valsartan) works
Entresto (sacubitril / valsartan) is a combination of two medications that work together to treat heart failure. Together, they're known as an angiotensin receptor-neprilysin inhibitor (ARNI).
Sacubitril is a neprilysin inhibitor. It works by blocking a protein in your body called neprilysin. This prevents the breakdown of substances called natriuretic peptides. These help relax your blood vessels and lower your blood pressure. They're important for preventing worsening of heart failure.
Valsartan is an angiotensin receptor blocker (ARB). It blocks angiotensin II, a hormone that narrows blood vessels. In doing so, valsartan relaxes blood vessels, which lowers your blood pressure and allows more blood to get to your heart and other organs.
Drug Facts
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What are the side effects of Entresto (sacubitril / valsartan)?
Common Side Effects
- Low blood pressure (18%)
- High potassium levels (12%)
- Cough (9%)
- Dizziness (6%)
- Kidney problems (5%)
Other Side Effects
- Rash
- Itching
- Falls
Serious Side Effects
- Angioedema: swelling of the eyes, face, tongue, throat, hands, feet, legs, or genitals
- Serious kidney problems: urinating less often than usual, swelling in your feet, ankles, or hands, unexplained weight gain
- High blood potassium levels: nausea, tiredness, chest pain, muscle weakness, tingling or numbness, pounding heart, nausea
- Severely low blood pressure: lightheadedness, dizziness, feeling faint, tiredness, confusion
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- High potassium level—muscle weakness, fast or irregular heartbeat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Entresto (sacubitril / valsartan)
Pros
First-choice treatment for heart failure
Can lower the risk of hospitalization
Combines two medications into one tablet for convenience
Available as tablets, oral pellets, or a prepared oral solution
Cons
Needs to be taken twice daily
Not safe during pregnancy
Can cause dizziness and low blood pressure
Only available as a fixed-dose tablet
Pharmacist tips for Entresto (sacubitril / valsartan)
You can take Entresto (sacubitril / valsartan) with or without food. If it upsets your stomach, try taking it with food to help.
You might feel dizzy the first few days after starting Entresto (sacubitril / valsartan) and with doses changes. This should get better or go away once your body adjusts to your new blood pressure. But if you feel dizzy or lightheaded, speak to your provider. You might need to have your dose of Entresto (sacubitril / valsartan) or other medications adjusted.
Make sure to mark your calendar with your appointments to see your provider and to get any blood work done when you take Entresto (sacubitril / valsartan). Your provider might order tests (e.g., potassium level, kidney health, blood pressure) during treatment and might change your dose of Entresto (sacubitril / valsartan) based on your lab results.
Entresto (sacubitril / valsartan) can raise your potassium levels which can lead to serious side effects, such as an irregular heartbeat. Your provider might ask you to limit foods that are high in potassium. Avoid using salt substitutes that contain potassium.
Make sure to have a healthy diet, including a low-salt diet, while taking Entresto (sacubitril / valsartan). This will help lower your blood pressure and lower the amount of fluid in your body, which helps make your heart not work as hard.
Entresto (sacubitril / valsartan) can interact with other medications. Make sure to tell your provider about all the medications you're taking before starting Entresto (sacubitril / valsartan). Also, don't start taking any new medications without talking to your provider or pharmacist first.
Don't take Entresto (sacubitril / valsartan) if you're pregnant. If you're pregnant or thinking of getting pregnant, contact your provider right away.
More tips for the Entresto (sacubitril / valsartan) liquid:
Store the liquid at room temperature and throw it away after 15 days, even if there's still medication left in the bottle.
Only use an oral syringe or medication dose cup from the pharmacy to measure out your dose. Never use household spoons because they aren't accurate, which can make you take the wrong dose.
Make sure to shake the liquid well before each dose.
More tips for the Entresto (sacubitril / valsartan) pellets:
Don't swallow the capsules that contain the oral pellets. Instead, open the capsule and sprinkle all the pellets onto 1 to 2 teaspoons of soft food, such as applesauce or yogurt.
Avoid chewing or crushing the pellets. Eat the food with the pellets right away to receive the full benefit of the medication.
Throw away the empty capsule shells after use.
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Frequently asked questions about Entresto (sacubitril / valsartan)
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What are the risks and warnings for Entresto (sacubitril / valsartan)?
Entresto (sacubitril / valsartan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for use during pregnancy
Entresto (sacubitril / valsartan) can cause birth defects and serious harm to unborn babies, so it shouldn't be taken during pregnancy. Talk to your provider about safer options to treat your blood pressure if you're pregnant or planning to become pregnant.
Swelling of face, tongue, or throat (angioedema)
Risk factors: Black people taking Entresto (sacubitril / valsartan) | History of angioedema
Angioedema, or swelling of the face, lips, tongue, throat, or other parts of your body, can happen at any time while you're taking Entresto (sacubitril / valsartan). This can cause breathing problems, which can be life-threatening. You shouldn't take Entresto (sacubitril / valsartan) if you've had angioedema from an ACE inhibitor or ARB in the past. Get medical attention right away if you notice any swelling in your face or neck or stomach pain.
Low blood pressure
Risk factors: Not enough fluid in your body | Having diarrhea or vomiting for a long time | Low salt levels in your body | Taking higher doses of diuretic medications
Entresto (sacubitril / valsartan) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. This side effect is more common when you first start Entresto (sacubitril / valsartan) or when the dose is raised. Your risk is higher if you're dehydrated or have medical conditions that cause you to become dehydrated, such as diarrhea or vomiting. Make sure to stay well-hydrated. If your blood pressure drops too much and you feel dizzy, make sure to sit down slowly while holding onto something and let your provider know. If you fall and hit your head, get medical help right away. If you feel dizzy, lightheaded, faint, tired, or confused while taking Entresto (sacubitril / valsartan), contact your provider right away.
Kidney damage
Risk factors: Heart failure | Kidney problems | Not enough fluid in your body | Taking other medications that can cause kidney damage
Entresto (sacubitril / valsartan) can affect your kidneys and cause them to not work as well. This can happen to anyone, but the effects can be more severe in folks with heart failure, people with existing kidney problems, or those who take medications that can worsen kidney function. Your provider might order lab tests every so often to make sure your kidneys are healthy and working properly. If you develop kidney problems (or if your kidney problems worsen) while taking Entresto (sacubitril / valsartan), your provider might recommend that you stop taking this medication. Let your provider know if you're urinating less often than usual, as this could be a sign that your kidneys aren't working as well.
High potassium levels
Risk factors: Taking other medications that can raise potassium levels
Entresto (sacubitril / valsartan) can cause high potassium levels, even in people with healthy kidneys. Your risk is higher if you take other medications that can raise potassium, such as spironolactone (Aldactone) or eplerenone (Inspra). If you experience signs of high potassium levels, such as nausea, muscle weakness, or abnormal heartbeat, tell your healthcare provider right away so your potassium level can be measured. If left untreated, high potassium levels can be dangerous.
Entresto (sacubitril / valsartan) dosage forms
Typical dosing for Entresto (sacubitril / valsartan)
Adults: The typical starting dose is 49 mg/51 mg (sacubitril/valsartan) by mouth twice a day. Your provider will raise your dose every 2-4 weeks, as needed. The typical maintenance dose is 97/103 mg (sacubitril/valsartan) twice a day.
Children: Your provider will determine your child's dose based on their body weight. If needed, they'll adjust your child's dose every 2 weeks. The dose is calculated based on the combined amount of sacubitril and valsartan in the oral liquid or oral pellets.
Oral liquid:
Weight less than 88 lbs: The typical starting dose is 1.6 mg/kg by mouth twice daily. The typical maintenance dose is 3.1 mg/kg twice daily.
Weight 88 lbs to less than 110 lbs: The typical starting dose is 24 mg/26 mg (sacubitril/valsartan) by mouth twice daily. The typical maintenance dose is 72 mg/78 mg (sacubitril/valsartan) twice daily.
Weight of 110 lbs or more: The typical starting dose is 49 mg/51 mg (sacubitril/valsartan) by mouth twice a day. The typical maintenance dose is 97/103 mg (sacubitril/valsartan) twice a day.
Oral pellets: Pellets are contained within each capsule
Weight 29 lbs to less than 42 lbs: The typical starting dose is 12 mg/12 mg by mouth twice daily. The typical maintenance dose is 24 mg/24 mg twice daily.
Weight 42 lbs to less than 57 lbs: The typical starting dose is 18 mg/18 mg (sacubitril/valsartan) by mouth twice daily. The typical maintenance dose is 30 mg/32 mg (sacubitril/valsartan) twice daily.
Weight 57 lbs to less than 75 lbs: The typical starting dose is 24 mg/24 mg (sacubitril/valsartan) by mouth twice daily. The typical maintenance dose is 45 mg/48 mg (sacubitril/valsartan) twice daily.
Weight 75 lbs to less than 110 lbs: The typical starting dose is 30 mg/32 mg (sacubitril/valsartan) by mouth twice daily. The typical maintenance dose is 60 mg/64 mg (sacubitril/valsartan) twice daily.
Your dose might differ if you have kidney or liver problems, or if you're not currently taking (or taking a low dose of) an angiotensin-converting enzyme (ACE) inhibitor or ARB.
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Entresto (sacubitril / valsartan) contraindications
History of angioedema from ACE inhibitor or ARB
Taking an ACE inhibitor within 36 hours of Entresto (sacubitril / valsartan)
Having diabetes (high blood sugar) and taking aliskiren (Tekturna) at the same time
What are alternatives to Entresto (sacubitril / valsartan)?
Heart failure in people ages 1 year or older
High blood pressure
Heart failure
Lower the risk for death after a heart attack
High blood pressure in adults and children
Lower the risk of hospitalization for heart failure in adults
Lower the risk of death after a heart attack in adults
What is the latest news about Entresto (sacubitril / valsartan)?
Entresto (sacubitril / valsartan) images
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References
Best studies we foundAmin, O. A., et al. (2021). The impact of discontinuation of sacubitril-valsartan and shifting to angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in patients with heart failure with reduced ejection fraction. Anatolian Journal of Cardiology.
Desai, A. S., et al. (2017). Reduced Risk of Hyperkalemia During Treatment of Heart Failure With Mineralocorticoid Receptor Antagonists by Use of Sacubitril/Valsartan Compared With Enalapril. JAMA Cardiology.
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.
Lee, N. S., et al. (2016). Current understanding of the compensatory actions of cardiac natriuretic peptides in cardiac failure: A clinical perspective. Cardiac Failure Review.
Montford, J. R., et al. (2017). How dangerous is hyperkalemia? Journal of the American Society of Nephrology.
Nicolas, D, et al. (2024). Sacubitril-valsartan. StatPearls.
Novartis Pharmaceuticals Corporation. (2024). Entresto- sacubitril and valsartan tablet, film coated; sacubitril and valsartan pellet [package insert]. DailyMed.
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