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

Medically reviewed by Carmen Pope, BPharm. Last updated on Apr 16, 2024.

What is Entresto?

Entresto is an oral combination heart medication that contains two blood pressure-lowering medications: sacubitril and valsartan. It may be used to

• reduce the risk of being admitted to a hospital for heart failure or dying from cardiovascular disease in adults with chronic heart failure. Those who benefit the most have a left ventricular ejection fraction (LVEF) below normal
• to treat symptomatic heart failure in children aged one year and older with systemic LVEF. Entresto reduces levels of NT-proBNP; a laboratory marker that indicates reduced LVEF, and it may also improve cardiovascular outcomes.

Sacubitril and valsartan, the ingredients in Entresto, work differently. Valsartan blocks a hormone called angiotensin II, which can harm the heart in heart failure patients, by blocking angiotensin II receptors. This prevents the hormone from causing harm to the heart and helps widen blood vessels, allowing blood to flow through more easily.

Sacubitril prevents the breakdown of natriuretic peptides, which are hormones that are secreted by the heart in response to high blood pressure or high sodium levels. These hormones promote the excretion of sodium and water into the urine. By preventing their breakdown, more sodium and water are excreted, which lowers the workload on the heart and decreases blood pressure. Together, these medications ease the burden on the failing heart. Entresto is called an angiotensin receptor-neprilysin inhibitor (ARNi).

Entresto was FDA-approved on July 7, 2015. Entresto is available as oral tablets and Entresto Sprinkle which can be sprinkled on food.

Warnings and serious effects

You should not use Entresto if you are allergic to sacubitril or 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:

• an ACE inhibitor, such as benazepril, captopril, enalapril, or lisinopril, or
• an ARB, such as candesartan, irbesartan, losartan, or telmisartan

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 (Tekturna, Tekamlo).

Entresto can be a serious allergic reaction called angioedema that 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.

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

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.

What are the side effects of Entresto?

Get emergency medical help if you have signs of an allergic reaction to Entresto: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African American.

Entresto can cause serious side effects (see Entresto warnings and side effects above).

Call your doctor at once if you have:

• a light-headed feeling, like you might pass out
• extreme tiredness
• high potassium - slow heart rate, weak pulse, muscle weakness, tingly feeling or
• kidney problems - little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath.

The most common side effects of Entresto affecting 5% or more people are low blood pressure, high potassium levels, cough, dizziness, and kidney problems.

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:

• have a history of hereditary angioedema
• have kidney or liver problems
• have diabetes
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

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. Use effective birth control.

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.

It is not known whether sacubitril and valsartan pass into breast milk or if they could harm a nursing baby. You should not breastfeed while using Entresto.

How should I take Entresto?

Take Entresto or Entresto Sprinkles exactly as prescribed by your doctor. Follow all directions on your prescription label. 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.

• Entresto or Entresto Sprinkle is taken 2 times each day.
• Your doctor may change your dose during treatment.

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.

• Your pharmacist will prepare this for you.
• Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

If you or your child are prescribed Entresto Sprinkle:

• This contains oral pellets inside of a capsule that must be opened and sprinkled onto 1 to 2 teaspoonfuls of soft food and taken right away.
• Do not swallow the capsules.
• Do not chew or crush the oral pellets.
• Use all of the oral pellets in the capsule. Do not use part of a capsule to try to prepare a dose.
• Do not take or give the Sprinkle through a nasogastric tube (NG Tube), gastrostomy tube (G Tube), or other feeding tubes because it may clog the tube.

Check to make sure you have received the correct prescribed strength of Entresto Sprinkle before taking or giving the dose (see ingredients below).

If you or your child are switching between Entresto, the prepared Entresto suspension, or Entresto Sprinkle, your healthcare provider may adjust your dose as needed.

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.

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:

• 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
• a diuretic or "water pill"
• NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

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.

Storage

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

• Protect from moisture.

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.

• Do not refrigerate tablets prepared as an oral suspension.

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).

Film coating contains:

• iron oxide black (E172) (24/26 and 97/103 mg tablets)
• iron oxide yellow (E172) (49/51 mg Entresto)

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).

• Iron oxide yellow (15/16 mg)

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

Entresto Sprinkle is available in 2 strengths:

• 6 mg/6 mg (sacubitril 6 mg and valsartan 6 mg). White cap, number 04 printed on it.
• 15 mg/16 mg (sacubitril 15 mg and valsartan 16 mg). Yellow cap, number 10 printed on it.

Manufacturer

Novartis Pharmaceuticals Corporation.

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Further information

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

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