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Entresto

Pronunciation: En-TRESS-toh
Generic name: sacubitril and valsartan
Brand names: Entresto, Entresto Sprinkle
Dosage form: oral tablets, oral pellets
Drug class: Angiotensin receptor blockers and neprilysin inhibitors

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 1, 2024.

What is Entresto?

Entresto is an oral combination prescription heart medication that contains two blood pressure-lowering medications: sacubitril and valsartan. Entresto is used to treat adults with long-lasting (chronic) heart failure to help reduce the risk of death and hospitalization and to treat certain children aged 1 year and older who have symptomatic heart failure.

Entresto contains sacubitril and valsartan, which each have a different mechanism of action. Sacubitril works by blocking neprilysin, an enzyme that breaks down certain peptides in the body. This increases levels of beneficial peptides in the body which relax blood vessels and promote sodium and water excretion into the urine, reducing blood pressure. Valsartan blocks the effects of a hormone called angiotensin II, which can cause blood vessels to narrow and increase blood pressure. Entresto belongs to the class of medicines known as angiotensin receptor-neprilysin inhibitors (ARNi).

Entresto gained FDA approval on July 7, 2015. Entresto is available as oral tablets and Entresto Sprinkle which can be sprinkled on food. Generic Entresto tablets are available under sacubitril and valsartan.

Entresto side effects

The most common side effects of Entresto are:

Serious side effects and warnings

Entresto carries a Boxed Warning for fetal toxicity (harm to an unborn baby).

Entresto or Entresto Sprinkle can harm or cause death to your unborn baby. Talk to your doctor about other ways to treat heart failure if you plan to become pregnant. Do not use Entresto if you are pregnant. Stop using and tell your doctor right away if you become pregnant. Entresto can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

Entresto can cause serious allergic reactions called angioedema which can cause swelling of your face, lips, tongue, and throat that may cause trouble breathing and death. Get emergency medical help right away if you have symptoms of angioedema or trouble breathing and do not take Entresto again. People who are African American, or who have had angioedema before, are at higher risk of developing angioedema. Do not take Entresto if you are allergic to sacubitril, valsartan (Diovan), Entresto, any of the inactive ingredients in the tablets or pellets, or if you have ever had a severe allergic reaction, such as angioedema (a serious swelling under the skin) to a blood pressure medication such as:

Get emergency medical help if you have signs of an allergic reaction to Entresto such as hives; difficulty breathing; or swelling of your face, lips, tongue, or throat.

Entresto should not be taken with an ACE inhibitor, or within 36 hours of taking one. If you have diabetes or kidney disease, do not use Entresto together with any medication that contains aliskiren (brand names Tekturna or Tekamlo).

Low blood pressure is common during treatment with Entresto, especially if you also take water pills (diuretics). Call your doctor if you become dizzy, lightheaded, or if you develop extreme tiredness (fatigue).

Kidney problems are common during treatment with Entresto and can be serious and can lead to kidney failure. Your healthcare provider will check your kidney function during treatment. Entresto may also increase levels of potassium in your blood and you will also be monitored for this.

Increased amount of potassium in your blood (hyperkalemia). Increased blood potassium levels are common during treatment with Entresto. Your doctor will check your potassium blood level during
your treatment.

Call your doctor at once if you have:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Before taking this medicine

Before taking Entresto, tell your doctor about all of your medical conditions, including if you:

Pregnancy

Do not use Entresto if you are pregnant. Stop using and tell your doctor right away if you become pregnant. Entresto can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. If you are a female with childbearing potential, your doctor may ask you to do a pregnancy test before starting Entresto and you should use effective birth control while taking it.

Breastfeeding

It is not known if Entresto or Entresto Sprinkle passes into your breast milk. You should not breastfeed during treatment. Talk to your healthcare provider about the best way to feed your baby during this time.

How should I take Entresto?

Take Entresto or Entresto Sprinkle exactly as prescribed by your doctor. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

If you or your child cannot swallow tablets, or if tablets are not available in the prescribed strength, you or your child may take Entresto tablets prepared as a liquid (oral) suspension or Entresto Sprinkle.

If you or your child are prescribed Entresto Sprinkle:

Entresto dosage

Entresto adult recommended starting dose: Entresto 49/51 mg 2 times daily.

Entresto child recommended starting dose: The dosage of Entresto for children is based on weight.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up for the missed dose.

What happens if I overdose?

Dosages are based on weight in children. Your child's dose needs may change if the child gains or loses weight. If you take too much Entresto or Entresto Sprinkle, call your doctor right away, seek emergency medical attention, or call the Poison Help line at 1-800-222-1222.

What to avoid

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Do not use potassium supplements or salt substitutes while you are taking Entresto unless your doctor has told you to.

Avoid drinking too much alcohol with Entresto. Drinking alcohol can further lower your blood pressure and may increase certain side effects of Entresto.

What other drugs will affect Entresto?

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking Entresto or Entresto Sprinkle with certain other medicines may affect each other or cause serious side effects. Especially tell your doctor if you take:

This list is not complete. Other drugs may interact with sacubitril and valsartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Entresto and Medicare

Because of the prescription drug law, known as the Inflation Reduction Act, Medicare can negotiate directly with drug companies to improve access to some of the costliest single-source brand-name Medicare Part B and Part D drugs.

Entresto is one of 10 drugs covered under Medicare Part D that were selected in 2024 for the first cycle of negotiation based on Total Expenditures under Part D and other criteria as required by the law. Negotiations with participating drug companies are ongoing, and any negotiated prices for the first cycle of negotiation is effective from 2026.

Storage

Store Entresto tablets or Entresto Sprinkle oral pellets at room temperature between 68°F to 77°F (20°C to 25°C).

Store bottles of Entresto that have been prepared as an oral suspension at room temperature less than 77°F (25°C) for up to 15 days.

Keep out of the reach of children.

Entresto ingredients

Entresto tablets

Active ingredients: sacubitril and valsartan

Inactive ingredients: colloidal silicon dioxide, crospovidone, low-substituted hydroxypropyl cellulose, magnesium stearate (vegetable origin), microcrystalline cellulose, and talc. Film coat: hypromellose, iron oxide red (E172), polyethylene glycol 4000, talc, and titanium dioxide (E171).

The film coating contains:

Entresto tablets are available in the following strengths:

When Entresto tablets are made into a suspension the prepared Entresto oral suspension also contains Ora-Sweet SF and Ora-Plus.

Entresto Sprinkle

Inactive ingredients: colloidal silicon dioxide, hydroxypropyl cellulose, magnesium stearate (vegetable origin), microcrystalline cellulose, and talc.

Film-coating: basic butylated methacrylate copolymer, sodium lauryl sulfate, stearic acid, and talc.

Capsule shell: hypromellose and titanium dioxide (E171).

Printing ink: shellac, propylene glycol, iron oxide red (E172), ammonia solution (concentrated), and potassium hydroxide.

Entresto Sprinkle is available in 2 strengths:

Who makes Entresto?

Novartis Pharmaceuticals Corporation makes Entresto.

Popular FAQ

Does Entresto improve ejection fraction?

Yes, Entresto has been shown to increase left ventricular ejection fraction (LVEF) in the PROVE-HF trial in patients with heart failure. Entresto is usually administered with other heart failure therapies in place of an ACE inhibitor or other ARB medication. Heart failure occurs when your heart cannot pump blood properly. Continue reading

Which drugs increase ejection fraction?

People with heart failure with reduced ejection fraction (also called HFrEF or systolic heart failure) usually need to take several types of medicines. At first, this may involve 3 different medicines from 3 different drug classes: a diuretic, an agent that blocks the renin-angiotensin system (ACE inhibitor, ARB or ARNI), and a beta blocker. Continue reading

What is the normal ejection fraction of the heart?

A normal ejection fraction ranges from 50% to 70%. Ejection fraction (EF) describes how well your heart chambers (the left or right ventricles) can pump blood to your body to deliver oxygen and nutrients. Patients with heart failure usually have an ejection fraction of 40% or less. Continue reading

How much does Entresto cost per month?

If you are paying cash, the cost for Entresto is around $734 per month for 60 tablets, but most people do not pay this price. If you have commercial insurance, you may be able to get up to a 90 day supply of Entresto for $10 using a copay card. Continue reading

Can Entresto be cut in half or split?

The manufacturer of Entresto (sacubitril and valsartan) suggests that if you cannot swallow the tablet, or if the correct strength is not available, you may take Entresto tablets prepared as a liquid oral suspension by your pharmacist or use the Entresto Sprinkle oral pellets, as prescribed by your healthcare provider. Continue reading

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.