What you need to know about Entresto (sacubitril / valsartan)


Entresto (sacubitril / valsartan) is a prescription medicine to treat chronic heart failure in adults and some types of heart failure in children older than 1 year. Approved by the FDA on July 7, 2015, with an extension of its indications in 2021, Entresto belongs to a class of drugs known as angiotensin receptor neprilysin inhibitors (ARNI). It combines two drugs: valsartan , which is also prescribed separately for the treatment of heart failure (under the brand name Diovan), and sacubitril, which can only be found in Entresto. Most people take Entresto as a pill, but it can be made as a liquid for children and adults who cannot swallow the tablets.

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Entresto is approved for the treatment of:

  • Adults with class II, III or IV heart failure with reduced ejection fraction (HFrEF).
  • Adults with heart failure with preserved ejection fraction (HFpEF).
  • Children older than 1 year with left ventricular systolic dysfunction and symptoms of this condition.

Heart failure includes moderate to severe activity limitation and varying degrees of symptoms and discomfort at rest and / or during physical activity. The goal of treatment is to reduce the need for hospitalization and to reduce mortality from chronic heart failure.

In adult studies, Entresto was found to be superior to other heart failure medications in reducing hospital admissions and deaths from chronic heart failure. In a study of more than 8,000 people with heart failure, this drug was shown to help people live longer and outside the hospital compared to enalapril , another leading heart failure drug.

The two active ingredients in Entresto lower blood pressure through different mechanisms:

  • Valsartine, an angiotensin II receptor blocker (ARB), prevents the narrowing of blood vessels by blocking the action of certain enzymes and peptides, thereby lowering blood pressure and improving blood flow.
  • Sacubitril, a neprilysin inhibitor, increases the levels of certain peptides (small proteins) that have a beneficial effect on blood flow in patients with heart failure.

Entresto is usually given together with other heart failure medications, either in place of another ARB or in place of an angiotensin converting enzyme (ACE) inhibitor.

Before drinking

Your healthcare provider may prescribe Entresto if you have a low ejection fraction and experience symptoms such as pain during exercise or at rest, or limitation of your physical activity due to heart failure. It may also be prescribed if you have been hospitalized for heart failure in the past 12 months.

Before taking Entresto, make sure your healthcare professional is aware of the latest information about your medical history. Of particular concern are:

  • Any chronic disease, especially with kidney or liver damage.
  • History of allergies causing hives and swelling.

Your healthcare provider should also know about all of the prescription, over-the-counter, and dietary supplements you are taking, including but not limited to:

If you are taking an ACE inhibitor, you must stop taking it and wait at least 36 hours before you can start taking Entresto.

Precautions and contraindications.

Entresto may not be safe for you if:

  • Allergy to sacubitril or valsartan
  • You have an allergic reaction (symptom such as swelling of the face, lips, tongue, or throat, or difficulty breathing) to an ACE inhibitor or ARB. Black people have been found to have a higher reaction rate to Entresto.
  • You have diabetes and are taking Tekturna (aliskiren) or a medicine that contains aliskiren.

Entresto can harm a developing child. If you are pregnant or planning to become pregnant, or if you are breastfeeding, you should not take this medication unless there is an alternative and your healthcare provider determines that the benefit outweighs the risk to your baby. Likewise, if you become pregnant while already taking Entresto, tell your doctor immediately so they can find a safer medicine for you.

Entresto doesn't have a long history of use, so little is known about how it might affect conditions like Alzheimer's or prostate cancer.

Salt substitutes containing potassium should not be consumed while taking Entresto.


Entresto is available as a film-coated tablet in three strengths:

  • 24 milligrams (mg) sacubitril / 26 mg valsartan
  • 49 mg sacubitril / 51 mg valsartan
  • 97 mg sacubitril / 103 mg valsartan

The manufacturer recommends that adults start with an average dose of 49/26 mg and increase to 97/103 mg after two to four weeks if the drug is well tolerated.

All indicated doses are indicated by the manufacturer of the drug. Check your prescription and talk to your doctor to make sure you are taking the correct dose.


The manufacturer also recommends giving children Entresto liquid twice a day in doses based on weight, also starting with a low dose and increasing to a higher dose if necessary and well tolerated.

How to take and store

You can take Entresto with meals or on an empty stomach. Take each dose at the same time every day. If you miss a dose, take it as soon as you realize you forgot, unless it is time for the next dose, in which case wait. When giving Entresto Liquid to your child, shake the bottle well before measuring the dose.

Entresto should be stored in the tightly closed container in which it arrived, out of the reach of children. Store the tablets at room temperature, away from heat and moisture (not in the bathroom). Store Entresto Liquid at room temperature for up to 15 days; do not refrigerate it.

Side effects

Like all medicines, Entresto can cause side effects.


  • Cough
  • Exhausted
  • Dizziness, lightheadedness, and fainting after getting up too quickly from a lying position
  • Elevated potassium levels

Severe form

  • Angioedema , which is a rash, itching, or swelling of the tongue, throat, or face that causes shortness of breath and death.
  • Low blood pressure (hypotension)
  • Kidney problems

Warnings and interactions

You should not take Entresto if you are taking an ACE inhibitor or ARB, or if you have ever had an allergic reaction with edema to an ACE inhibitor or ARB treatment.

A Discussion Guide for Health Professionals in Heart Failure

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