Entresto (Sacubitril and Valsartan) – Oral

Warning:

Stop Entresto as soon as possible if you are pregnant and tell your healthcare provider immediately. This medicine can cause death or harm to the fetus.

What Is Entresto?

Entresto (sacubitril and valsartan) is an oral prescription combination drug used to treat adults with heart failure. It belongs to a class of medications called angiotensin receptor-neprilysin inhibitors (ARNis).

Sacubitril is a neprilysin inhibitor. It causes blood vessels to dilate, which lowers blood pressure. Valsartan is an angiotensin II receptor blocker (ARB). Angiotensin II is a hormone. It causes the body to hold salt and water and constricts blood vessels, which increases blood pressure.

Angiotensin II has receptors in the kidneys, heart, blood vessels, brain, and adrenal glands. ARBs block the receptors and lower the hormone's effects, and therefore reduce blood pressure. ARBs also prevent damage to the kidneys and the heart.

Entresto is available as a tablet. However, pharmacists can compound it into an oral suspension (liquid) for children and adults who cannot swallow.

Drug Facts

Generic Name: Sacubitril and valsartan

Brand Name(s): Entresto

Drug Availability: Prescription

Therapeutic Classification: Angiotensin receptor-neprilysin inhibitor

Available Generically: No

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Sacubitril and valsartan

Dosage Form(s): Tablet, oral suspension

What Is Entresto Used For?

The Food and Drug Administration (FDA) has approved Entresto for use in adults with chronic heart failure and children 1 year of age and older with symptomatic heart failure. 

Heart failure (weak heart) is a condition in which the heart is unable to pump enough blood to meet the body’s needs. Entresto reduces the chances of hospital visits due to heart failure. It also lowers the chances of dying of heart failure.

Entresto (Sacubitril and Valsartan) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Entresto

Use Entresto as directed by your healthcare provider. Take it with or without food, 12 hours apart. Continue taking your medicine even if you feel well. Do not suddenly stop taking your medication. 

The pharmacist can also make a liquid (oral suspension) for children or adults with difficulty swallowing. If you are taking the suspension, shake it well before use. Use a measuring cup or syringe to measure each dose. Ask your pharmacist for a measuring device if you do not have one.

Storage

Store in a safe, dry place at (68–77 degrees Fahrenheit). Do not store it in a bathroom. Keep your medicine away from children and pets. Store suspension at room temperature. Do not refrigerate. Throw away any remainder after 15 days.

Do not allow yourself to run out of medication. Always call in your refills on time. Contact your healthcare provider if you need more pills.

How Long Does Entresto Take to Work?

It takes Entresto levels between 30 minutes to two hours to peak. Steady levels can take up to two weeks. Your healthcare provider may wait about two weeks before adjusting the dose.

What Are the Side Effects of Entresto?

Like other medications, Entresto can cause side effects. Tell your healthcare provider if you have any side effects while taking this medication.

This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

People taking Entresto experience mild to no side effects. However, the most commonly reported side effect is cough.

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:

Long-Term Side Effects

It is unknown if there are long-term side effects associated with Entresto.  However, it is suspected to be linked to cognitive dysfunction (a noticeable decline in mental abilities such as memory and thinking skills) and Alzheimer’s disease (progressive cognitive decline).

Report Side Effects

Entresto may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Entresto Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

  • For oral dosage form (tablets):
    • For heart failure:
      • For patients taking Entresto® with an ACE inhibitor or ARB:
        • Adults—At first, 1 tablet of 49 milligrams (mg) of sacubitril and 51 mg of valsartan 2 times a day. After 2 to 4 weeks, your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 1 tablet of Entresto® 97/103 mg two times a day.
        • Children 1 year of age and older and weighing at least 50 kilograms (kg)—Dose is based on body weight and must be determined by your doctor. The starting dose is 1 tablet of Entresto® 49/51 mg two times a day. Your doctor will increase your dose every 2 weeks as needed and tolerated. However, the dose is usually not more than 1 tablet of Entresto® 97/103 mg two times a day.
        • Children 1 year of age and older and weighing at least 40 kg to less than 50 kg—Dose is based on body weight and must be determined by your doctor. The starting dose is 1 tablet of Entresto® 24/26 mg two times a day. Your doctor will increase your dose every 2 weeks as needed and tolerated. However, the dose is usually not more than 3 tablets of Entresto® 24/26 mg two times a day.
        • Children 1 year of age and older and weighing less than 40 kg—Dose is based on body weight and must be determined by your doctor. The starting dose is 1.6 mg per kg of body weight two times a day. Your doctor will increase your dose every 2 weeks as needed and tolerated. However, the dose is usually not more than 3.1 mg per kg of body weight two times a day.
        • Children younger than 1 year of age—Use and dose must be determined by your doctor.
      • For patients not currently taking an ACE inhibitor or ARB and for patients previously taking low doses of ACE inhibitor or ARB:
        • Adults—At first, 1/2 tablet of Entresto® 49/51 mg two times a day. After 2 to 4 weeks, your doctor may double your dose as needed and tolerated. However, the dose is usually not more than 1 tablet of Entresto® 97/103 mg two times a day.
        • Children 1 year of age and older and weighing at least 50 kilograms (kg)—Dose is based on body weight and must be determined by your doctor. The starting dose is 1/2 tablet of Entresto® 49/51 two times a day. Your doctor will increase your dose every 2 weeks as needed and tolerated. However, the dose is usually not more than 1 tablet of Entresto® 97/103 mg two times a day.
        • Children 1 year of age and older and weighing at least 40 kg to less than 50 kg—Dose is based on body weight and must be determined by your doctor. The starting dose is 0.8 mg per kg of body weight two times a day. Your doctor will increase your dose every 2 weeks as needed and tolerated. However, the dose is usually not more than 3 tablets of Entresto® 24/26 mg two times a day.
        • Children 1 year of age and older and weighing less than 40 kg—Dose is based on body weight and must be determined by your doctor.
        • Children younger than 1 year of age—Use and dose must be determined by your doctor.

Modifications

For children or people who cannot swallow, pharmacists can prepare a liquid form of the drug. This compound comes as a 4 milligrams per milliliter (mg/ml) oral suspension. Shake well before use.

Stop Entresto as soon as possible if you are pregnant and tell your healthcare provider immediately. This medicine can cause death or harm to the fetus. It is unknown if Entresto is present in breast milk. Due to possible harm in infants, do not breastfeed while on this medication.

Missed Dose

If you miss a dose of your medicine, take it as soon as you can. If it is too close to your next dose, skip the missed dose and return to your regular time. Do not take extra doses or two doses at a time.

Overdose: What Happens If I Take Too Much Entresto?

Overdose symptoms may include:

  • Low heart rate
  • Decreased alertness
  • Reduced breathing

What Happens If I Overdose on Entresto?

If you think someone may have overdosed on Entresto, contact a healthcare provider or Poison Control Center at 800-222-1222.

If a person has collapsed or is not breathing after a suspected overdose, call 911.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.

Do not take this medicine for at least 36 hours before or after you take an ACE inhibitor medicine.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Ask your doctor before you use medicines, supplements, or salt substitutes that contain potassium.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Entresto?

Do not take Entresto if you:

  • Are pregnant, because this drug can cause injury or death to your baby
  • Have a history of angioedema despite the cause, since valsartan can cause angioedema
  • Are taking angiotensin-converting enzyme (ACE) inhibitors, which increase the risk of angioedema
  • Are hypersensitive to sacubitril, valsartan, or any part of the combination
  • Have diabetes and are also taking a renin inhibitor called Tekturna (aliskiren)

What Other Medications Interact With Entresto?

Entresto may interact with other medications. Before starting Entresto, talk to your healthcare provider about any other prescription or over-the-counter medications you are taking.

The following medications may interact with Entresto:

  • ACE inhibitors
  • Sodium phosphates
  • Lithium
  • Tekturna (aliskiren)

ACE Inhibitors 

ACE (angiotensin-converting enzyme) inhibitors treat high blood pressure and heart failure. ACE inhibitors increase the side effects of Entresto. Notably, the risk of angioedema increases. Your healthcare provider must allow a 36-hour washout period (time between medications) when switching you from or to an ACE inhibitor.

Sodium Phosphates 

Sodium phosphates treat short-term constipation and serve as bowel cleansing drugs for colonoscopy prep. However, taking sodium phosphates with Entresto can increase kidney damage due to the presence of valsartan, an ARB, in Entresto.

Your healthcare provider may stop your medication briefly when you are on sodium phosphates. If you must take them together, stay well hydrated. Your provider should watch your kidneys very closely.

Lithium

Lithium is a medicine that treats bipolar disorder. ARBs may increase lithium levels in the body and therefore cause more side effects. Your provider may have to reduce the dose of your lithium if you have to take Entresto.

Tekturna (Aliskiren)

Tekturna is a renin inhibitor used to lower blood pressure. Entresto should not be taken with Tekturna in people with diabetes.

What Medications Are Similar?

Other medications that treat heart failure, like Entresto, include:

Diovan (Valsartan)

Diovan is an ARB. It treats high blood pressure and other heart conditions. Diovan has more side effects than Entresto. It can cause rare reactions like rhabdomyolysis (muscle breakdown), orthostatic hypotension (blood pressure falls when standing up or sitting down), hepatitis (liver inflammation due to infection by a virus), and thrombocytopenia (very low platelet count, which may cause nose and gum bleeds).

Atacand (Candesartan)

Atacand is an ARB that treats high blood pressure and other heart conditions. However, Entresto increases the risk of low blood pressure and increased potassium in the body, whereas Atacand does not. Atacand also has fewer side effects than Entresto.

Altace (Ramipril)

Altace is an ACE inhibitor. It treats heart failure and high blood pressure. It also reduces the risk of stroke, heart attack, and death from heart problems. Ramipril has more side effects, including a more persistent cough than Entresto. It also has more drug-drug interactions. Do not take this at the same time as Entresto.

This is a list of drugs also prescribed for heart failure. It is not a list of drugs recommended to take with Entresto. You should not take these drugs together. Ask your pharmacist or healthcare provider if you have any questions.

How Can I Stay Healthy While Taking Entresto?

You may be asking, "What's next? How can I keep my heart healthy while on Entresto?"

Don't worry. Here are some steps you can take:

  • Check your blood pressure daily at home. You can also check it at your nearby pharmacy. Most pharmacies have blood pressure monitor machines on-site. If you need help, ask your pharmacist. You can also talk to your health insurance provider; they may be able to send you a free blood pressure machine.
  • Adopt a heart-healthy diet and try to cut back on salt to help manage heart problems and prevent fluid retention.
  • If you're overweight, losing excess pounds can help lessen the strain on your heart.
  • Get in some regular, moderate exercise. This can include walking, using an exercise bike, stretching, or lifting light weights.

You should also be aware of the potential side effects of this medication. Tell your provider right away if you are sweating a lot, throwing up, or having loose stools, which can cause low blood pressure. Watch out for a severe and deadly side effect called angioedema. Look for signs like swelling of the face, lips, hands, eyes, or throat.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

Was this page helpful?
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Entresto label.

  2. Khalil P, Kabbach G, Said S, Mukherjee D. Entresto, a new panacea for heart failure? Cardiovasc Hematol Agents Med Chem. 2018;16(1):5-11.

  3. Novartis. Novartis to present new Entresto HFpEF and HFrEF data at ESC Congress 2019.

  4. Krittanawong C, Kitai T. Pharmacogenomics of angiotensin receptor/neprilysin inhibitor and its long-term side effects. Cardiovasc Ther. 2017;35(4). doi:10.1111/1755-5922.12272

  5. Fala L. Entresto (sacubitril/valsartan): First-in-class angiotensin receptor neprilysin inhibitor FDA approved for patients with heart failure. Am Health Drug Benefits. 2015;8(6):330-334.

  6. U.S. National Library of Medicine. DailyMed. Entresto- sacubitril and valsartan tablet, film coated.

  7. Food and Drug Administration. Diovan label.

  8. Food and Drug Administration. Atacand label.

  9. Food and Drug Administration. Altace label.