Entresto is a prescription brand-name medication used to treat certain types of heart failure. This is a condition in which your heart is weak and can't pump enough blood to the rest of your body.

Entresto contains two drugs. One is sacubitril, which is a type of medication called a neprilysin inhibitor. The second drug is valsartan, which is a type of medication called an angiotensin II receptor blocker (ARB).

Entresto comes as a tablet in different strengths. You take Entresto two times each day. If you can't swallow tablets, your pharmacist can crush Entresto and mix it with a liquid for you to drink. This form is called an oral suspension, and you'd take it using an oral syringe.

What it does

Entresto is approved to be used in people with a type of chronic (ongoing) heart failure that's classified as New York Heart Association (NYHA) Class II–IV.* They must also have reduced ejection fraction, which means that the left side of their heart is pumping out less blood than usual. The goal of the treatment is to help you live longer and reduce the risk of a heart failure-related hospital stay.

Entresto is usually given with other heart failure treatments instead of a different ARB or an angiotensin converting enzyme (ACE) inhibitor.

Entresto is also approved to be used in children ages 1 year and older who have a certain type of heart failure with symptoms. It's called systemic left ventricular systolic dysfunction, which means that parts of the left side of the heart aren't working as well as they should.

* For more about this type of heart failure, see the "Entresto for heart failure" section below.

Effectiveness

A study looked at adults who had certain types of chronic heart failure with symptoms. The study found that Entresto was effective when compared with enalapril, which is an angiotensin converting enzyme (ACE) inhibitor. People in the study took either Entresto or enalapril for up to 4.3 years.

The results showed the following:

  • The number of heart-related deaths was lower for people who took Entresto (9%) than for people who took enalapril (10.9%).
  • Fewer people who took Entresto (12.8%) required a hospital stay for heart failure than people who took enalapril (15.6%).
  • People who took Entresto had better overall survival rates than people who took enalapril. The rate of death in the Entresto group was 17%, compared with 19.8% in the enalapril group.

Entresto is available only as a brand-name medication. It's not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be just as safe and effective as the original drug. Generics also tend to cost less than brand-name drugs.

Entresto contains two active drug ingredients: sacubitril and valsartan. As the active drugs, sacubitril and valsartan are the ingredients that make Entresto work.

Entresto can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Entresto. These lists don't include all possible side effects.

For more information on the possible side effects of Entresto, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you've had with Entresto, you can do so through MedWatch.

More common side effects

The more common side effects of Entresto can include:

  • cough
  • dizziness

Most of these side effects may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Entresto aren't common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Serious side effects and their symptoms can include the following:

Other serious side effects, explained in more detail below in "Side effect details," include:

  • severe allergic reaction
  • hypotension (low blood pressure)
  • fetal toxicity (harm to your unborn baby)*

*Entresto has a boxed warning for fetal toxicity. This is the most serious warning from the FDA. For more information, see "FDA warning: Fetal toxicity (harm to your unborn baby)" at the beginning of this article.

Side effects in children

In clinical studies of Entresto, side effects in children were similar to those in adults and occurred just as often. A clinical study testing Entresto's effectiveness in children is still ongoing. More information about side effects in children will be provided from the manufacturer in the future.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here's some detail on several of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Entresto. In a study of adults with heart failure, 0.5% of people who took Entresto and 0.2% of people who took enalapril had angioedema. This is a type of severe allergic reaction.

A severe allergic reaction, which includes angioedema, can cause the following symptoms:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

You may have a higher risk for angioedema while taking Entresto if you're black or if you've had angioedema in the past.

It's also possible to have a mild allergic reaction to Entresto. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

If you have a severe allergic reaction to Entresto, tell your doctor right away. They may have you stop taking the drug and suggest a different medication. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Cough

Cough was a common side effect reported in people who took Entresto. In a study of adults with heart failure, 9% of adults who took Entresto and 13% of adults who took enalapril had a cough.

If you have a cough that concerns you while taking Entresto, talk with your doctor. They can suggest treatments to help you feel better.

Low blood pressure

Low blood pressure, which is also called hypotension, can occur while taking Entresto. It was one of the most common side effects reported in a large clinical study of the drug. Researchers found that 18% of people who took Entresto developed low blood pressure, compared with 12% of people who took enalapril.

You may be more likely to develop low blood pressure during your Entresto treatment if you're also taking other drugs that can lower blood pressure. Examples of these medications include diuretics (water pills).

Symptoms of low blood pressure can include:

  • dizziness
  • lightheadedness
  • extreme tiredness
  • feeling dizzy or falling when moving from a lying position to seated or standing

If you notice any of these symptoms, tell your doctor right away. They may have you stop taking Entresto and use a different medication.

Kidney failure

Kidney failure can occur with Entresto. In a large clinical study of adults with heart failure, 5% of people who took Entresto and 5% of people who took enalapril had kidney failure.

While you're taking Entresto, your doctor may monitor your kidney function for any signs of kidney failure. If there are changes in how your kidneys are working, your doctor may lower your dose of Entresto or have you stop taking the drug for a time.

Hyperkalemia

Hyperkalemia, which is a high level of potassium in the blood, is a common side effect of taking Entresto. During a clinical study of people with heart failure, hyperkalemia was reported in 12% of those who took Entresto and in 14% of those who took enalapril.

While you're taking Entresto, your doctor may monitor your potassium level. If the level is high, your doctor may reduce your dose of Entresto or have you stop taking the drug for a time.

Shortness of breath

Shortness of breath wasn't specifically reported with Entresto use in a large clinical study of adults with heart failure. However, shortness of breath can be a sign of a severe allergic reaction from using Entresto. These reactions include angioedema. (See the "Allergic reaction" section above to learn more.)

If you're short of breath, it could also be a sign that your heart failure is worsening. The condition can cause shortness of breath that's brought on with activity or rest. It's important that you track any shortness of breath you have and share this information with your doctor.

If you have trouble breathing, call your doctor right away. And call 911 if your symptoms feel life threatening or if you think you're having a medical emergency.

Skin rash

Rashes can occur with Entresto use. They were reported as a side effect of the drug once Entresto was on the market and available by prescription.

If you have a rash while taking Entresto, this may be a sign that you're having an allergic reaction to the medication. (See the "Allergic reaction" section above to learn more.)

If you're concerned about your rash, you should tell your doctor. They may recommend that you stop using Entresto and take a different drug instead.

Harm to your unborn baby

Entresto has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Taking Entresto while you're pregnant can cause fetal toxicity, which is a type of harm to your unborn baby. The drug can cause the baby's kidneys to not work well and lead to death. It's not known how often this occurs with Entresto, a placebo, or a comparison drug.

If you become pregnant while taking Entresto, stop taking the drug right away and tell your doctor. They may recommend a different drug for your heart failure.

Weight gain (not a side effect)

Weight gain didn't occur in the clinical studies of Entresto. But with heart failure, it's very common to have rapid changes in your weight. An increase in your weight may mean that your heart failure is getting worse. This may be because your heart isn't pumping properly, so fluid is collecting in your body.

You should track your weight each day and share this information with your doctor at every visit.

If you notice sudden changes in your weight or if your weight concerns you, speak with your doctor. They can see if your heart failure is the cause and suggest treatments that may help.

The Entresto dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you're using Entresto to treat
  • your age and weight
  • the form of Entresto you take
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they'll adjust it over time to reach the amount that's right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Entresto comes as a tablet that's available in three strengths:

  • 24/26 mg. This strength contains 24 mg of sacubitril and 26 mg of valsartan, and it may be called 50 mg (24 mg + 26 mg).
  • 49/51 mg. This strength contains 49 mg of sacubitril and 51 mg of valsartan, and it may be called 100 mg (49 mg + 51 mg).
  • 97/103 mg. This strength contains 97 mg of sacubitril and 103 mg of valsartan, and it may be called 200 mg (97 mg + 103 mg).

Entresto tablets are meant to be swallowed. But if you're unable to swallow tablets, your pharmacist can crush them and mix them with a liquid for you to drink. This form is called an oral suspension.

The pharmacist will use Entresto 49/51-mg tablets to prepare the suspension. The final strength of the suspension will be 800 mg/200 mL, which is 4 mg/1 mL.

Dosage for heart failure

The starting dosage for Entresto is 49/51 mg twice a day. After 2 to 4 weeks, your doctor may double the dosage to 97/103 mg twice a day.

Pediatric dosage

Like adults, children ages 1 year and older will typically take Entresto twice a day. For young children, including those who weigh less than 88 lb (40 kg), it's recommended that the drug be given as an oral suspension. You'll need to measure the required dose with an oral syringe.

Entresto doses for children are based on their weight and age. Their doctor will increase the dose every 2 weeks until a final dose amount is reached.

Children who weigh less than 88 lb (40 kg)

The usual starting dose is 1.6 mg/kg. After 2 weeks, your child's doctor may increase the dose to 2.3 mg/kg. And after 4 weeks, the dose may be increased to 3.1 mg/kg.

A pharmacist will prepare the oral suspension and explain how much your child will need to take.

Children who weigh between 88 lb and 110 lb (40 kg and 50 kg)

The usual starting dose is 24/26 mg. After 2 weeks, your child's doctor may increase the dose to 49/51 mg. And after 4 weeks, the dose may be increased to 72/78 mg.

The 72/78-mg recommended dose can be reached by using three 24/26-mg tablets.

Children who weigh 110 lb (50 kg) or more

The usual starting dose is 49/51 mg. After 2 weeks, your child's doctor may increase the dose to 72/78 mg. And after 4 weeks, they may increase the dose to 97/103 mg.

What if I miss a dose?

If you miss a dose of Entresto, be sure to take it as soon as you remember. If the timing is too close to your next dose, just take your next scheduled dose. Be sure not to take more than one dose at a time. Taking multiple doses may increase your risk for more side effects. (See the "Entresto side effects" section above to learn more.) You should speak with your doctor about any missed doses, if you're concerned.

To help make sure that you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Entresto is meant to be used as a long-term treatment. If you and your doctor determine that Entresto is safe and effective for you, you'll likely take it long term.

As with all medications, the cost of Entresto can vary. To find current prices for Entresto in your area, check out GoodRx.com:

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you'll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before approving coverage for Entresto. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the information and let you and your doctor know if your plan will cover Entresto.

If you're not sure if you'll need to get prior authorization for Entresto, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Entresto, or if you need help understanding your insurance coverage, help is available.

Novartis Pharmaceuticals Corporation, the manufacturer of Entresto, offers a program called Entresto Central. This program may help lower the cost of your Entresto prescription. For more information and to find out if you're eligible for support, call 800-245-5356 or visit the program website.

The Food and Drug Administration (FDA) approves prescription drugs such as Entresto to treat certain conditions. Entresto is FDA-approved to treat some types of heart failure.

Entresto may be used in people with a type of chronic (ongoing) heart failure that's classified as New York Heart Association (NYHA) Class II–IV.* They must also have reduced ejection fraction, which means that the left side of their heart is pumping out less blood than usual. The goal of the treatment is to help you live longer and reduce the risk of a heart failure-related hospital stay.

One of the drugs in Entresto, valsartan, is a type of medication called an angiotensin II receptor blocker (ARB). Entresto is usually given with other heart failure treatments instead of a different ARB or an angiotensin converting enzyme (ACE) inhibitor.

Entresto may also be used in children ages 1 year and older who have a certain type of heart failure with symptoms. It's called systemic left ventricular systolic dysfunction, which means that parts of the left side of the heart aren't working as well as they should.

* Based on the severity of your symptoms, your doctor will usually classify your heart failure. They may use a common system called the NYHA Functional Classification.

What is heart failure?

Heart failure is a condition that occurs when your heart is weak and can't pump enough blood to the rest of your body. When your blood flow is decreased, major organs (such as your lungs or kidneys) don't work properly. This is because your body's cells depend on your heart to deliver blood to them. The blood is filled with the oxygen and nutrients your organs' cells need.

Common symptoms of heart failure can include:

  • shortness of breath
  • swelling in your ankles, feet, or legs
  • coughing
  • confusion or memory loss
  • rapid weight gain
  • feeling tired or fatigued (lacking energy)

Different heart conditions may lead to heart failure. For example, cardiomyopathy is a disease of the heart muscle that may cause you to have heart failure. In cardiomyopathy, the muscle of the heart becomes too thick or too thin, rigid, or enlarged. The heart weakens and is less able to pump blood throughout the body.

There are different types of heart failure. One type is known as congestive heart failure (CHF). With CHF, the blood flowing from the heart slows to form a bottleneck with the blood that's returning to the heart. This backup causes congestion in your body's tissues. Symptoms such as edema (swelling) and shortness of breath may occur as the fluid collects in your body.

Effectiveness

A study looked at adults who had certain types of chronic heart failure with symptoms. The study found that Entresto was effective when compared with enalapril, which is an ACE inhibitor. People in the study took either Entresto or enalapril for up to 4.3 years.

The results showed the following:

  • The number of heart-related deaths was lower for people who took Entresto (9%) than for people who took enalapril (10.9%).
  • Fewer people who took Entresto (12.8%) required a hospital stay for heart failure than people who took enalapril (15.6%).
  • People who took Entresto had better overall survival rates than people who took enalapril. The rate of death in the Entresto group was 17%, compared with 19.8% in the enalapril group.

In addition to being used to treat heart failure (see the "Entresto for heart failure" section above), Entresto is sometimes used off-label for other conditions. Off-label drug use is when a drug that's approved for one use is used for a different one that's not approved. And you may wonder if Entresto is used for certain other conditions.

Entresto for hypertension (off-label use)

Entresto isn't approved to treat high blood pressure. However, a study of Japanese people with severe high blood pressure found that Entresto was effective at reducing blood pressure.

After 8 weeks, people in the study had a decrease of 35.3 mmHg in their systolic blood pressure (the top number of a blood pressure reading). They had a decrease of 22.1 mmHg in their diastolic blood pressure (the bottom number). There was no comparison group in this study, but most of the people took other blood pressure drugs along with Entresto.

If you'd like to learn more about the use of Entresto in treating high blood pressure, talk with your doctor.

Entresto for heart failure with preserved ejection fraction (not an approved use)

Entresto isn't approved to treat heart failure with preserved ejection fraction. Ejection fraction is a measurement of how much blood the left side of your heart pumps out in a heartbeat. So with this type of heart failure, your heart is pumping out a normal (preserved) amount of blood.

In a study, Entresto was compared with valsartan in adults who had heart failure and preserved ejection fraction. Researchers found a 13% lower risk of heart failure-related hospital stays and deaths due to cardiovascular causes with Entresto, compared with valsartan. However, these results were not considered statistically different, which means the difference between groups may have occurred by chance.

If you have heart failure with preserved ejection fraction, speak with your doctor about treatments that are right for you.

Entresto is usually taken along with other heart failure medications. These medications include diuretics (also known as water pills) and beta-blockers.

Diuretics help lower blood pressure by telling your kidneys to pass salt and water in urine. Lower blood pressure reduces how hard your heart has to work to pump blood. Examples of commonly used diuretics include:

  • furosemide (Lasix)
  • bumetanide (Bumex)
  • hydrochlorothiazide (Microzide)
  • metolazone (Zaroxolyn)

Beta-blockers help treat heart failure by blocking the effects of stress hormones on your heart. This reduces how hard your heart has to work to pump blood. Examples of commonly used beta-blockers are:

  • metoprolol succinate (Toprol XL)
  • bisoprolol
  • carvedilol (Coreg)
  • atenolol (Tenormin)

Other drugs are available that can treat heart failure. Some may be better suited for you than others. If you're interested in finding an alternative to Entresto, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use is when a drug that's approved for one use is used for a different one that's not approved.

Other drugs that may be used to treat heart failure include:

  • ivabradine (Corlanor)
  • lisinopril (Zestril, Prinivil)
  • enalapril (Vasotec, Epaned)
  • fosinopril
  • captopril
  • perindopril
  • quinapril (Accupril)
  • ramipril (Altace)
  • trandolapril
  • losartan (Cozaar)
  • valsartan (Diovan)
  • candesartan (Atacand)
  • spironolactone (Aldactone)
  • eplerenone (Inspra)
  • digoxin (Lanoxin)

You may wonder how Entresto compares with other medications that are prescribed for similar uses. Here we look at how Entresto and enalapril are alike and different.

Ingredients

Entresto contains two active drugs: sacubitril and valsartan. Enalapril contains one active drug: enalapril.

Uses

The Food and Drug Administration (FDA) has approved both Entresto and enalapril to treat heart failure. This is a condition in which your heart is weak and can't pump enough blood to the rest of your body.

Entresto uses

Entresto is FDA-approved for use in people with a type of chronic (ongoing) heart failure that's classified as New York Heart Association (NYHA) Class II–IV.* They must also have reduced ejection fraction, which means that the left side of their heart is pumping out less blood than usual. The goal of the treatment is to help you live longer and reduce the risk of a heart-failure related hospital stay.

Entresto is usually given with other heart failure treatments instead of a different ARB or an angiotensin converting enzyme (ACE) inhibitor.

Entresto is also approved to be used in children ages 1 year and older who have a certain type of heart failure with symptoms. It's called systemic left ventricular systolic dysfunction, which means that parts of the left side of the heart aren't working as well as they should.

* Based on the severity of your symptoms, your doctor will usually classify your heart failure. They may use a common system called the NYHA Functional Classification.

Enalapril uses

Enalapril is FDA-approved to treat adults with congestive heart failure who have symptoms. The drug is usually prescribed with other drugs for this purpose. Enalapril is also approved to treat high blood pressure in children and adults, and a type of heart problem called asymptomatic left ventricular dysfunction (the left side of the heart doesn't work properly).

Drug forms and administration

Both Entresto and enalapril come as tablets that you take two times each day for heart failure. If you can't swallow tablets, your pharmacist can crush the drugs and mix them with a liquid for you to drink. This form is called an oral suspension.

Side effects and risks

Entresto and enalapril are both used to treat heart failure, but they contain different drugs. Therefore, the medications can cause side effects that are similar and different. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Entresto, with enalapril, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Entresto, with enalapril, or with both drugs (when taken individually).

  • Can occur with Entresto:
  • Can occur with enalapril:
  • Can occur with both Entresto and enalapril:
    • fetal toxicity (harm to your unborn baby)
    • severe allergic reaction
    • hypotension (low blood pressure)

Effectiveness

Entresto and enalapril have different FDA-approved uses, but they're both used to treat heart failure in adults.

The use of Entresto and enalapril in treating heart failure has been directly compared in a clinical study.

Researchers looked at adults who had certain types of chronic heart failure with symptoms.

Entresto was effective when compared with enalapril in adults with certain types of chronic heart failure having symptoms. People in the study took either Entresto or enalapril for up to 4.3 years. The results showed the following:

  • The number of heart-related deaths was lower for people who took Entresto (9%) than for people who took enalapril (10.9%).
  • Fewer people who took Entresto (12.8%) required a hospital stay for heart failure than people who took enalapril (15.6%).
  • People who took Entresto had better overall survival rates than people who took enalapril. The rate of death in the Entresto group was 17%, compared with 19.8% in the enalapril group.

Costs

Entresto is a brand-name drug, and it's not currently available in generic form. Enalapril is a generic drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Entresto costs significantly more than enalapril. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Like enalapril (above), the drug losartan has uses similar to those of Entresto. Here's a comparison of how Entresto and losartan are alike and different.

Ingredients

Entresto contains two active drugs: sacubitril and valsartan. Losartan contains one active drug: losartan.

Uses

Here's some information about the uses of Entresto and losartan.

Entresto uses

Entresto is FDA-approved for use in people with a type of chronic (ongoing) heart failure that's classified as New York Heart Association (NYHA) Class II–IV.* They must also have reduced ejection fraction, which means that the left side of their heart is pumping out less blood than usual. The goal of the treatment is to help you live longer and reduce the risk of a heart failure-related hospital stay.

Entresto is usually given with other heart failure treatments instead of a different ARB or an angiotensin converting enzyme (ACE) inhibitor.

Entresto is also approved to be used in children ages 1 year and older who have a certain type of heart failure with symptoms. It's called systemic left ventricular systolic dysfunction, which means that parts of the left side of the heart aren't working as well as they should.

* Based on the severity of your symptoms, your doctor will usually classify your heart failure. They may use a common system called the NYHA Functional Classification.

Losartan uses

Losartan is FDA-approved to:

  • treat high blood pressure in adults as well as children ages 6 years and older
  • reduce the risk of stroke in adults with high blood pressure and left ventricular hypertrophy (LVH). LVH is a disorder in which the heart's left pumping chamber becomes thick and isn't able to pump as well.
  • treat diabetic nephropathy (a serious kidney disease brought on by diabetes) in adults with type 2 diabetes and a history of high blood pressure

Drug forms and administration

Entresto and losartan both come as tablets. Entresto is taken twice a day, while losartan is taken once a day.

If you can't swallow tablets, your pharmacist can crush the drugs and mix them with a liquid for you to drink. This form is called an oral suspension.

Side effects and risks

Entresto contains a drug that's an angiotensin II receptor blocker (ARB), and losartan is an ARB. Therefore, the medications can cause side effects that are similar and different. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Entresto, with losartan, or with both drugs (when taken individually).

  • Can occur with Entresto:
    • cough
  • Can occur with losartan:
  • Can occur with both Entresto and losartan:
    • dizziness

Serious side effects

These lists contain examples of serious side effects that can occur with Entresto, with losartan, or with both drugs (when taken individually).

  • Can occur with Entresto:
  • Can occur with losartan:
    • few unique serious side effects
  • Can occur with both Entresto and losartan:

Effectiveness

Entresto and losartan have different FDA-approved uses.

These drugs haven't been directly compared in clinical studies, but studies have found both Entresto and losartan to be effective for treating heart failure. However, losartan isn't FDA-approved to treat heart failure, so that would be considered an off-label use. (Off-label drug use is when a drug that's approved for one use is used for a different one that's not approved.)

Costs

Entresto is a brand-name drug, and it's not currently available in generic form. Losartan is a generic drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Entresto costs significantly more than losartan. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Here are answers to some frequently asked questions about Entresto.

Is Entresto a beta-blocker?

No, Entresto isn't a type of drug called a beta-blocker because it works differently than beta-blockers.

Entresto helps your heart pump blood throughout your body more easily. Beta-blockers work by stopping the action of hormones such as adrenaline and noradrenaline. This helps lower your heart rate and blood pressure.

Your doctor may want you to use Entresto with a beta-blocker to help manage your heart failure. Talk with them if you have any questions about your medications.

Can I use Entresto if I'm on dialysis?

Entresto hasn't been studied in people with heart failure who are on dialysis. (Dialysis is a treatment that removes waste and excess water, and sometimes drugs, from your blood.) Therefore, it's hard to determine how well Entresto would work and if it's is safe to use while you're on dialysis.

Entresto attaches tightly to proteins in your blood, which means the drug can't be removed during dialysis. Kidney problems such as kidney failure are possible serious side effects of using Entresto. (To learn more, see the "Entresto side effects" section above.) So if your kidneys aren't working properly and you aren't on dialysis, your doctor will likely give you a lower dose of Entresto.

If you have heart failure and are currently on dialysis, talk with your doctor to find the right medication for your condition.

Will Entresto affect my BNP level?

Yes. Taking Entresto can affect your B-type natriuretic peptide (BNP) level. BNP is a hormone that your heart makes. Your doctor may check your blood levels of BNP and a related hormone called NT-proBNP to monitor your heart failure.

BNP and NT-proBNP levels typically go up when heart failure worsens. They'll go down when heart failure is stable. BNP and NT-proBNP don't cause heart failure. They're just chemical markers that your doctor uses to check your heart health and your heart's response to Entresto.

Sacubitril, one of the active drugs in Entresto, blocks your body from breaking down BNP. This causes BNP levels to rise when you take Entresto. Sacubitril doesn't block the breakdown of NT-proBNP, though, so NT-proBNP levels will fall when you take Entresto.

Your doctor will factor in Entresto's effects on BNP and NT-proBNP when they review your blood test results.

Can I still exercise if I'm using Entresto?

Yes, you can remain active with different types of exercise while taking Entresto. According to the American College of Cardiology, examples of activities that may be recommended for some people with heart failure include:

  • walking
  • rowing
  • cycling
  • climbing stairs
  • lifting weights
  • using the weight of your body for exercises

Speak with your doctor about the kinds of exercise activities that may be right for you. Being active every day is an important part of managing heart failure. To help you stay on track, your doctor may have you join a cardiac rehabilitation program. This program has trained staff who can teach you how to exercise safely.

It's important to note your daily activities while taking Entresto. Share this information with your doctor at every visit. This way, they can see how much exercise you're getting.

The manufacturer of Entresto, Novartis Pharmaceuticals Corporation, offers a patient program that provides lifestyle support, including exercise tips, while you're taking Entresto. You can register for the program by phone at 888-ENTRESTO (888-368-7378) or online.

Is Entresto a diuretic?

No, Entresto isn't a diuretic. Diuretics are a kind of medication that reduce the amount of fluid in your body. They're also called water pills.

Entresto contains two drugs. One is sacubitril, which is a type of medication called a neprilysin inhibitor. The second drug is valsartan, which is a type of medication called an angiotensin II receptor blocker (ARB).

Because Entresto and diuretics work in different ways, they'll help with different heart failure symptoms. The diuretic lessens any swelling from fluids building up in your body, especially in your lower legs and ankles. Entresto helps your heart pump blood throughout your body more easily.

Your doctor may want you to use Entresto and a diuretic to help manage your heart failure.

If I'm taking an ACE inhibitor, can I switch to using Entresto?

Yes, if you're taking a drug called an angiotensin converting enzyme (ACE) inhibitor, your doctor may have you switch to Entresto. They may choose to prescribe Entresto if an ACE inhibitor isn't effective enough for you.

However, there's an increased risk of angioedema (a type of severe allergic reaction) when Entresto and an ACE inhibitor are used together. So you shouldn't take Entresto within 36 hours of using an ACE inhibitor. That's how long it takes for the ACE inhibitor to be out of your system. Your doctor may refer to this 36-hour window of time as a "washout period."

If you have any questions about switching from an ACE inhibitor to Entresto, talk with your doctor.

There are no known interactions between Entresto and alcohol. However, drinking too much alcohol can lead to or worsen heart failure. You should speak with your doctor about whether it's safe for you to drink while you're using Entresto.

Entresto can interact with several other medications. It may also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Entresto and other medications

Below is a list of medications that can interact with Entresto. This list doesn't contain all drugs that may interact with Entresto.

Before taking Entresto, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Entresto and angiotensin converting enzyme (ACE) inhibitors

Taking Entresto and a drug called an angiotensin converting enzyme (ACE) inhibitor may increase your risk for angioedema (a type of severe allergic reaction). So you shouldn't take Entresto within 36 hours of using an ACE inhibitor. That's how long it takes for the ACE inhibitor to be out of your system.

Examples of ACE inhibitors include:

  • enalapril (Vasotec)
  • lisinopril (Zestril, Prinivil)
  • fosinopril
  • captopril
  • perindopril
  • quinapril (Accupril)
  • ramipril (Altace)
  • trandolapril

If you're taking an ACE inhibitor, talk with your doctor before you start using Entresto. They can help with the timing of the two medications.

Entresto and angiotensin II receptor blockers (ARBs)

One of the two drugs in Entresto is valsartan, which is an angiotensin II receptor blocker (ARB). Taking Entresto with another ARB may raise the level of the ARBs in your body and increase your risk for side effects. (For more about side effects, see the "Entresto side effects" section above.)

Examples of ARBs include:

  • valsartan (Diovan)
  • losartan (Cozaar)
  • candesartan (Atacand)

If you're taking an ARB, talk with your doctor before you start using Entresto. They may suggest that you stop taking the ARB before you begin Entresto treatment.

Entresto and certain diuretics

Diuretics are a kind of medication that reduce the amount of fluid in your body. They're also called water pills. Certain diuretics that prevent your body from getting rid of potassium are known as potassium-sparing diuretics.

A possible side effect of Entresto is hyperkalemia (a high level of potassium in the blood). So taking Entresto with a potassium-sparing diuretic may increase the level of potassium in your body even more.

Examples of potassium-sparing diuretics include:

  • spironolactone (Aldactone)
  • amiloride (Midamor)
  • triamterene (Dyrenium)
  • eplerenone (Inspra)

If you're taking a potassium-sparing diuretic, tell your doctor before you start using Entresto. They'll monitor the potassium level in your blood to help make sure it's normal throughout your treatment.

Entresto and lithium

Taking Entresto with lithium (Lithobid) can cause the lithium to rise to an unsafe level in your body. This can lead to serious side effects.

If you're taking lithium with Entresto, your doctor will monitor your lithium level and side effects more closely. They may recommend a different dosage of lithium.

Entresto and herbs and supplements

There aren't any herbs or supplements that have been specifically reported to interact with Entresto. However, you should still check with your doctor or pharmacist before using any of these products while taking Entresto.

Entresto and foods

Entresto isn't known to interact with any foods.

Heart failure is a condition that occurs when your heart is weak and can't pump enough blood to the rest of your body. When your blood flow is decreased, major organs (such as your lungs or kidneys) don't work properly. This is because your body's cells depend on your heart to deliver blood to them. The blood is filled with the oxygen and nutrients your organs' cells need.

Common symptoms of chronic heart failure can include:

  • shortness of breath
  • swelling in your legs, ankles, or feet
  • coughing
  • confusion or memory loss
  • rapid weight gain
  • feeling tired or fatigued (lacking energy)

Based on the severity of your symptoms, your doctor will usually classify your heart failure. They may use a common system called the New York Heart Association (NYHA) Functional Classification.

What Entresto does

Entresto contains two drugs. One is sacubitril, which belongs to a class of drugs called neprilysin inhibitors. (A class of drugs is a group of medications that work in a similar way.) The other drug is valsartan, which is an angiotensin II receptor blocker (ARB).

Neprilysin is a protein known as an enzyme, and it breaks down "good" substances called peptides. (Peptides are small versions of proteins, and these peptides help remove sodium and fluid from your body.) The drug sacubitril blocks the action of neprilysin, causing more peptides to form. This leads to the removal of more sodium and fluid from your body, which helps your heart work more easily.

Valsartan works by blocking the effect of the hormone angiotensin II. This helps make your blood vessels relax more. It also allows your kidneys to get rid of extra water and salt. The result is usually lower blood pressure. This puts less stress on your heart.

Both actions of sacubitril and valsartan work together to help your heart pump blood throughout your body more easily.

How long does it take to work?

After taking Entresto, it may be several days before your heart failure symptoms begin to ease.

Using more than the recommended dosage of Entresto can lead to serious side effects.

Overdose symptoms

Symptoms of an overdose can include hypotension (low blood pressure).

What to do in case of overdose

If you think you've taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

You should take Entresto according to your doctor's or healthcare provider's instructions.

Entresto comes as a tablet. If you can't swallow tablets, your pharmacist can crush Entresto and mix it with a liquid for you to drink. This form is called an oral suspension, and you'd take it using an oral syringe.

When to take

You'll typically take Entresto two times each day. Try to remember to take your doses of the drug at the same time every day. It's a good idea to space them about 12 hours apart.

To help make sure that you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

During your treatment with Entresto, your doctor may change your dosage based on your symptoms and if you're having any side effects.

Taking Entresto with food

You can take Entresto with or without food.

Can Entresto be crushed, split, or chewed?

There are no recommendations regarding splitting or chewing Entresto tablets.

But if you have trouble swallowing Entresto tablets, your pharmacist can crush them into a fine powder and mix it with a liquid for you to drink. This form is called an oral suspension.

Work with your doctor to determine the best way for you take Entresto.

You shouldn't take Entresto while you're pregnant. The drug can cause fetal toxicity (harm to your unborn baby) if you take the drug while pregnant.

Entresto has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Taking Entresto while you're pregnant can cause your baby's kidneys to not work well and lead to death. If you become pregnant while taking Entresto, stop taking the drug right away and tell your doctor. They may recommend a different drug for your heart failure. Your doctor may also perform ultrasound scans to check on you and your baby.

If you were taking Entresto while you were pregnant, your newborn baby may be observed for certain side effects. These include hypotension (low blood pressure), hyperkalemia (high level of potassium in the blood), and oliguria (making small amounts of urine).

You shouldn't take Entresto during pregnancy. If you're sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you're using Entresto.

Breastfeeding isn't recommended while you're taking Entresto. It's not known if the drug transfers into human breast milk or what the effects of Entresto are on breastfed children.

In animal studies, Entresto was found to pass into the breast milk of breastfed animals whose mothers were given the drug. But it's important to keep in mind that animal studies don't always predict what will occur in humans.

If you're planning to breastfeed, talk with your doctor before you start taking Entresto. They can review the best ways for you to feed your child and what heart failure treatment is right for you.

This drug comes with several precautions.

FDA warning: Harm to your unborn baby

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Taking Entresto while you're pregnant can cause fetal toxicity, which is a type of harm to your unborn baby. The drug can cause the baby's kidneys to not work well and lead to death. If you become pregnant while taking Entresto, stop taking the drug right away and tell your doctor. They may recommend a different drug for your heart failure.

Other warnings

Before taking Entresto, talk with your doctor about your health history. Entresto may not be right for you if you have certain medical conditions. These include:

  • Angioedema. If you've had angioedema while taking an angiotensin II receptor blocker (ARB) or an angiotensin converting enzyme (ACE) inhibitor, you're more likely to have it again if you use Entresto. Angioedema is a type of severe allergic reaction. Ask your doctor what other heart failure treatments are better options for you.
  • Allergic reaction. If you've had an allergic reaction to Entresto or any of its ingredients, you shouldn't take Entresto. Ask your doctor what other heart failure treatment is a better choice for you.
  • Diabetes. If you have diabetes and are taking a medication called aliskiren (Tekturna), you shouldn't use Entresto. Taking Entresto and aliskiren at the same time can put you at an increased risk for kidney problems such as kidney failure, hyperkalemia (a high level of potassium in the blood), and hypotension (low blood pressure). Ask your doctor what other medications may be better choices for you.
  • Severe liver disease. Entresto isn't recommended in people with severe liver disease. If you have liver disease, talk with your doctor to find out if Entresto is right for you.
  • Pregnancy. You shouldn't take Entresto while pregnant. This drug has a boxed warning, which is the most serious warning from the FDA. For more information, please see the "Entresto and pregnancy" section above.
  • Breastfeeding. You shouldn't breastfeed while taking Entresto. For more information, please see the "Entresto and breastfeeding" section above.

Note: For more information about the potential negative effects of Entresto, see the "Entresto side effects" section above.

When you get Entresto from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store Entresto tablets at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

If you take Entresto as an oral suspension, you can store it at room temperature (68°F to 77°F/20°C to 25°C) for up to 15 days. (To prepare an oral suspension, your pharmacist will crush Entresto tablets and mix them with a liquid for you to drink.) You shouldn't refrigerate the oral suspension form of Entresto.

Disposal

If you no longer need to take Entresto and have leftover medication, it's important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Entresto (sacubitril/valsartan) is indicated for use in:

  • adults with certain types of chronic heart failure (New York Heart Association Class II–IV) and reduced ejection fraction to decrease the risk of cardiovascular death and hospitalization for heart failure
  • children ages 1 year and older who have symptomatic heart failure and systemic left ventricular systolic dysfunction

Entresto is usually given with other heart failure therapies. It's used in place of certain others, such as an angiotensin II receptor blocker (ARB) or an angiotensin converting enzyme (ACE) inhibitor.

Mechanism of action

Entresto contains two drugs. These are sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin II receptor blocker.

Entresto inhibits the neutral endopeptidase, neprilysin, through the active metabolite of sacubitril called LBQ657. Sacubitril is a prodrug. Valsartan blocks the angiotensin II type-1 (AT1) receptor, which inhibits the effects of angiotensin II.

Pharmacokinetics and metabolism

Following oral administration of Entresto, peak plasma concentrations are reached in 0.5 hours for sacubitril, 2 hours for LBQ657 (the active metabolite of sacubitril), and 1.5 hours for valsartan. After twice-a-day dosing with Entresto, steady state is reached in 3 days.

Sacubitril is metabolized via esterases to LBQ657. LBQ657 does not undergo appreciable metabolism. Valsartan is only minimally metabolized (approximately 20% of the dose).

The mean elimination half-life is 1.4 hours for sacubitril, 11.5 hours for LBQ657, and 9.9 hours for valsartan.

Contraindications

Entresto is contraindicated in patients who:

  • have a history of a hypersensitivity reaction to sacubitril, valsartan, or any of the other excipients in the product
  • have a history of angioedema due to previous ACE inhibitor or ARB therapy
  • are taking concomitant ACE inhibitors (must be separated by at least 36 hours)
  • have diabetes and are taking aliskiren

Storage

Entresto tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. Excursions are allowed from 59°F to 86°F (15°C to 30°C). Avoid storing this medication in moist areas.

The prepared Entresto suspension (liquid to be taken by mouth) can be stored at room temperature (68°F to 77°F/20°C to 25°C) for up to 15 days. The Entresto suspension shouldn't be refrigerated.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.