Is Entresto a blood thinner and does it lower blood pressure?

Key Points

• No, Entresto (generic name: sacubitril and valsartan) is not classified as a blood thinner. Entresto is a combination medication that contains the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan. It is used in patients with chronic (long-lasting) heart failure.
• Entresto helps to improve your body’s ability to pump blood to the heart. Entresto works by relaxing blood vessels, improving blood flow, and reducing stress on the heart. Entresto is usually given together with other heart medications or in place of an ACE inhibitor or other ARB.
• Entresto does lower blood pressure. The most common side effects with Entresto include low blood pressure, high potassium, cough, dizziness, and kidney problems.

What is Entresto used for?

Entresto, from the manufacturer Novartis, is used for the treatment of patients with chronic heart failure and reduced ejection fraction (HFrEF) to lower the risk of cardiovascular death and hospitalization due to heart failure. Heart failure occurs when the heart is weak and cannot pump enough blood to your lungs and the rest of your body.

Entresto relaxes blood vessels, improves blood flow, and reduces stress on the heart.

Entresto contains two medicines: sacubitril and valsartan.

• Sacubitril is a blood pressure medicine. It lowers blood pressure by increasing proteins in the body that can dilate (widen) blood vessels and by reducing sodium levels.
• Valsartan is classified as an angiotensin II receptor blocker (sometimes called an ARB). Valsartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

Clinically, Entresto is used with other standard heart failure medications such as beta-blockers, mineralocorticoid antagonists and other types of diuretics.

Low blood pressure with Entresto

Entresto lowers blood pressure and can cause complications due to low blood pressure (hypotension). Call your doctor if you become dizzy or lightheaded, or you feel extremely tired or fatigued.

In clinical studies conducted by the manufacturer, 18% of patients (18 out of every 100) treated with Entresto and 12% of patients treated with enalapril (Vasotec) reported low blood pressure (hypotension) as a side effect.

Low blood pressure may be more common if you also take water pills (diuretics). If you are dehydrated or have low levels of sodium (salt) in your blood you may also be more at risk for low blood pressure. Your doctor may need to correct your salt depletion or dehydration before you start treatment with Entresto.

Your doctor may also need to adjust your dose of Entresto or other medications, or temporarily stop treatment with Entresto, until your low blood pressure resolves. You will not usually have to stop taking Entresto permanently if you experience symptoms due to low blood pressure.

Tell your doctor about all of your medical conditions before you start treatment with Entresto. Let them know:

• if you have kidney or liver problems
• a history of hereditary angioedema
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed. You should either take Entresto or breastfeed, but you should not do both.

You should NOT take Entresto if you currently take an ACE inhibitor medicine, like lisinopril or enalapril. Do not take Entresto for at least 36 hours before or after you take an ACE inhibitor medicine due to an increased risk of angioedema (a type of severe allergic reaction). Talk with your doctor or pharmacist before taking Entresto if you are not sure if you take an ACE inhibitor medication.

Using Entresto with other medicines can cause serious side effects. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal or other dietary supplements.

Especially tell your doctor if you take:

• potassium supplements or a salt substitute
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• lithium
• other medicines for high blood pressure or heart problems such as an ACE inhibitor, ARB, or aliskiren

If you take too much Entresto (either accidental or intentional) low blood pressure is likely to occur due to the blood pressure lowering effects of Entresto. If you have taken too much Entresto, call your doctor or call for emergency help right away.

Related questions

• Which drugs increase ejection fraction?
• Does Entresto improve ejection fraction?
• What is the normal ejection fraction of the heart?

Bottom Line

• Entresto is not classified as a blood thinner; it is a medication used to treat chronic heart failure.
• Entresto helps to improve your body’s ability to pump blood to the heart. It works by relaxing blood vessels, improving blood flow, and reducing stress on the heart.
• Entresto can cause low blood pressure. The most common side effects with Entresto include low blood pressure, high potassium, cough, dizziness, and kidney problems.

This is not all the information you need to know about Entresto (generic name: sacubitril and valsartan) for safe and effective use. Review the full Entresto product information here, and discuss this information with your doctor or other health care provider.