Entresto is the brand name of a combination of two drugs, sacubitril and valsartan. It is intended to treat and prevent serious effects of heart failure. Your doctor may prescribe this drug alone or with other medications and lifestyle modifications.

Sacubitril works by preventing the breakdown of natriuretic peptides, which promote the excretion of sodium in the urine (natriuresis). The overall effect of this is a decrease in blood volume which in turn reduces blood pressure.

On the other hand, valsartan is an angiotensin II receptor blocker (ARB) which helps lower blood pressure. It also has an effect on blood vessels, allowing them to relax and decrease pressure.

Uses

What is Entresto used for?

Entresto is used in certain people with chronic heart failure. This medicine helps lower the risk of needing to be hospitalized when symptoms get worse, and helps lower the risk of death from heart failure.

Entresto is usually given together with other blood pressure medications.

How should I take Entresto?

Take Entresto 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.

You may take Entresto with or without food. Take the medicine at the same time each day.

Your blood pressure will need to be checked often. Your kidney function may also need to be checked.

How do I store Entresto?

Entresto is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store this product in the bathroom or the freezer. There may be different brands of Entresto that may have different storage needs. Therefore, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Entresto?

Consult with your doctor or pharmacist, if you are/have:

• Pregnant or breastfeeding.
• Taking any other medicines. This includes both prescription and over-the-counter (OTC) medications, such as herbal remedies and dietary supplements.
• Allergy with any of active or inactive ingredients of Zeffix or other medications.
• Any other types of allergies, such as to foods, dyes, preservatives, or animals.
• Any other illnesses, disorders, or medical conditions, such as liver problems or kidney problems.

You should not use Entresto if you have ever had a severe allergic reaction to a blood pressure medication such as:

• ACE inhibitors – benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril (Lotensin, Vasotec, Prinivil, Accupril, Mavik, and others)
• Other ARBs – azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan (Atacand, Avapro, Benicar, Diovan, Edarbi, Micardis, Teveten, and others)

You should not take Entresto within 36 hours before or after you have taken any ACE inhibitor medication.

If you have diabetes or kidney disease, do not use Entresto together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).

Is it safe during pregnancy or breastfeeding?

Do not take Entresto or other medications that contain valsartan, ARBs, or ACE inhibitors while pregnant. It is not recommended during the first trimester and it is contraindicated during the second and third trimesters of pregnancy. ACEIs and ARBs are known to be toxic to the fetus.

It is not known if Entresto is excreted in breastmilk. However, animal studies of valsartan and sacubitril showed that these drugs could pass into breastmilk. Because of this, it is not recommended for lactating mothers to breastfeed unless approved by a doctor or OB-GYN.

Side effects

What side effects can occur from 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.

Also 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
• Kidney problems – little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath

Common side effects may include:

• Dizziness
• Cough

Not everyone experiences these side effects. Additionally, there may be other side effects not listed above. If you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Entresto?

Entresto may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products that may interact with this drug are:

• Aliskiren
• Lithium
• Any other heart or blood pressure medicines
• A diuretic or “water pill”
• Medicine or mineral supplements that contain potassium
• NSAIDs (nonsteroidal anti-inflammatory drugs) – aspirin, ibuprofen, naproxen, celecoxib, diclofenac, indomethacin, meloxicam, and others

Does food or alcohol interact with Entresto?

Entresto may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Entresto?

Entresto may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Usual Adult Dose for Congestive Heart Failure:

Initial dose: take 100 mg tablet orally twice a day. Double the dose at 2-4 weeks to the target dose of 200 mg twice a day as tolerated by the patient.

If the patient is not currently taking an ACE inhibitor or ARB: start at 50 mg twice a day and slow dose titration (doubling every 3 to 4 weeks).

For patients with systolic BP >100-110 mmHg, moderate to severe renal impairment, or moderate hepatic impairment (Child-Pugh B): starting dose is 50 mg taken twice a day.

What is the dose for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Entresto available?

Entresto is available in the following dosage forms and strengths:

• Tablet, film-coated: 50 mg, 100 mg, 200 mg (each 50 mg contains sacubitril 24.3 mg + valsartan 25.7 mg)

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room. Signs and symptoms of an overdose or toxicity include:

• Dizziness
• Fainting
• Low urine output
• Headache
• Diarrhea
• Fatigue
• Muscle weakness
• Loss of consciousness

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.