Entresto, made simple.
Entresto combines two medicines, sacubitril and valsartan, to treat heart failure. It can help the heart work more effectively and lower the chance of heart failure hospital stays. The most important safety rule is simple: never take it with an ACE inhibitor. This guide explains how, and everything else you need to know. A Mississippi pharmacist wrote it for you.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeTwo rules you should never forget
- Entresto can injure or kill a developing baby. If you become pregnant, stop taking Entresto and contact your prescriber immediately. Talk with your care team about reliable birth control while you take it.
- Never take Entresto with an ACE inhibitor such as lisinopril, enalapril, benazepril, ramipril, or captopril. Taking them together can cause dangerous swelling called angioedema. Keep at least 36 hours between the last ACE inhibitor dose and Entresto, and between Entresto and a new ACE inhibitor.
Your 60 second Entresto safety checklist
- Never combine it with an ACE inhibitor.Taking them together can cause dangerous swelling called angioedema. A 36 hour washout is required when switching. Before your first dose, confirm when your last ACE inhibitor dose was taken.
- Take it twice daily.Usually morning and evening, with or without food. Use a consistent schedule and do not double a missed dose.
- Watch your blood pressure.Dizziness or faintness can happen, especially if you are dehydrated or take other blood pressure medicines. Rise slowly and report fainting or repeated low readings.
- Keep your potassium and kidney checks.The valsartan in Entresto can raise potassium and affect kidney function. Keep your lab appointments and ask before using potassium products or salt substitutes.
- Track swelling and weight.A sudden weight rise or new swelling may mean fluid buildup. Face or throat swelling may be angioedema. Seek emergency help for breathing or throat swelling.
- Prevent pregnancy.Entresto can injure or kill a developing baby. Contact your prescriber immediately if pregnancy occurs and discuss reliable birth control.
What Entresto is and why your doctor gave it to you
Entresto contains two medicines in one tablet: sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin receptor blocker, also called an ARB.
Doctors give it for heart failure.
- Chronic heart failure in adults. The benefits are clearest when the heart is pumping below normal strength. In the right patients, Entresto can reduce heart failure hospital stays and death from heart problems.
- Heart failure in children. Entresto is also approved for symptomatic heart failure with weakened pumping of the left side of the heart in patients 1 year and older.
The simple version: Entresto helps the body keep helpful signals that relax blood vessels, while blocking a hormone pathway that can strain the heart. Different patients get different strengths, based on previous medicines, blood pressure, kidney or liver function, age, and body size. Entresto is part of a complete heart failure plan. Do not stop your other medicines unless your doctor changes them.
How Entresto works
Think of heart failure as a circulation system under extra pressure. Your body releases helpful substances that relax blood vessels and remove sodium. But an enzyme called neprilysin breaks them down. Sacubitril blocks that enzyme, so those helpful signals last longer.
Valsartan blocks a hormone called angiotensin II at its receptor. That reduces blood vessel tightening and the signals that hold on to sodium and water.
Together, the two medicines can lower the pressure the heart pumps against and reduce harmful stress signals. Because these same pathways affect blood pressure, potassium, kidney function, pregnancy, and swelling risk, the follow up tests and the ACE inhibitor separation rule are essential.
Your dose
Entresto tablets have two numbers on them. Those are the amounts of sacubitril and valsartan. Your strength depends on your previous ACE inhibitor or ARB use, your blood pressure, your kidney and liver function, your age or body size, and how well you tolerate it.
Your prescriber may raise the strength after 2 to 4 weeks if you are doing well on it. Do not change it yourself.
If you cannot swallow tablets, ask about the labeled Entresto Sprinkle pellets or a pharmacist prepared suspension. Do not improvise your own mixture. Entresto Sprinkle capsules are opened and the pellets sprinkled on 1 to 2 teaspoons of soft food and taken right away. Do not swallow the capsule, chew or crush the pellets, or put them through a feeding tube unless the label and your care team specifically support that method.
One more rule: do not take another ARB, because Entresto already contains valsartan. If you have any question about your strength or form, ask Fairview. That is exactly what we are here for.
Timing, and what to do if you miss a dose
Take Entresto twice daily, usually morning and evening, with or without food. Use a consistent schedule.
If you are switching from an ACE inhibitor, at least 36 hours must pass between the last ACE inhibitor dose and your first Entresto dose.
If you miss a dose:
- Take the missed dose when you remember, unless it is close to the next scheduled dose.
- If it is close, skip it and go back to your regular schedule.
- Do not take two doses together.
- The label does not give an hour by hour cutoff, so ask Fairview to define what close means for your schedule.
- If you miss several doses, call your prescriber rather than restarting at a different strength.
Side effects, what is normal and what is not
You may notice when you begin treatment:
- Dizziness or low blood pressure. Rise slowly, and sit or lie down if lightheaded.
- A cough. It is generally less common than with ACE inhibitors, but report a persistent cough so other causes can be checked.
- Mild tiredness during the adjustment period. This may improve.
- Potassium or kidney test changes you cannot feel. That is why lab appointments matter.
Call your doctor or pharmacist promptly if you notice:
- New or worse ankle, leg, or belly swelling, shortness of breath, needing more pillows to sleep, or a rapid weight rise that reaches the threshold in your heart failure plan.
- Repeated dizziness, fainting, or unusually low blood pressure readings.
- Less urination, sudden weakness, an irregular heartbeat, or other signs of high potassium.
- Vomiting, diarrhea, heavy sweating, or poor fluid intake. These can lower blood pressure and strain the kidneys.
- Any lip, tongue, face, or throat swelling, even if breathing still feels normal. Seek urgent medical advice right away.
Get urgent help or call 911 if you have:
- Trouble breathing or swallowing, or swelling of the face, lips, tongue, or throat.
- Fainting that does not resolve, severe weakness, or signs of shock.
- Severe chest pain, stroke like symptoms, or loss of consciousness.
- Severe heart failure symptoms: gasping, blue lips, confusion, or being unable to lie flat.
What to be careful with
Give Fairview and your prescriber a complete list of everything you take. Here are the big ones.
ACE inhibitors are never allowed with Entresto. Separate them by at least 36 hours. Do not add another ARB either, because Entresto already contains valsartan. A medicine called aliskiren should not be combined with Entresto if you have diabetes, and may be unsafe with kidney problems.
Potassium supplements, potassium containing salt substitutes, and potassium sparing diuretics can raise your potassium. Ask before using any of them.
NSAID pain relievers like ibuprofen and naproxen can worsen kidney function, especially with dehydration, kidney disease, older age, or diuretics. Ask before taking them.
Lithium levels can rise on Entresto, so monitoring is required. Other blood pressure medicines, diuretics, and alcohol may add to dizziness or low blood pressure.
You do not need to memorize every interaction. Before starting, stopping, or changing another medicine or supplement, tell your pharmacist that you take Entresto.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
Availability and insurance coverage can change. Fairview will check whether an FDA approved lower cost alternative, a manufacturer savings program, an insurance exception, or another cost saving option is available for your specific prescription.
What should be checked
Entresto works quietly, and some of its most important changes happen in your labs, not in how you feel. Here is what your care team may follow.
Your doctor should check, now and then:
- Your blood pressure and any dizziness or fainting.
- Your kidney function and potassium, at the start and after dose changes.
- Your daily weight, swelling, breathing, and exercise tolerance.
- Pregnancy status when relevant.
Your pharmacist should, now and then:
- Check your medicine list for ACE inhibitors, ARBs, potassium products, NSAIDs, and lithium.
- Make sure your strength and schedule still fit your prescription.
- Ask about dizziness, swelling, and other side effects.
- Help you stay on schedule with refills.
Your monitoring plan depends on why you take the medicine, your dose, your other conditions, and your other medications.
Special situations
Pregnancy and pregnancy planning.
Entresto has a boxed warning for harm to a developing baby. Contact your prescriber immediately when pregnancy is detected so a safer heart failure plan can be arranged. Discuss reliable birth control with your care team.
Breastfeeding.
Because of the potential for serious reactions in a breastfed infant, the label advises choosing between breastfeeding and Entresto with your care team.
If you become sick or cannot eat or drink.
Vomiting, diarrhea, fever, or heavy sweating can cause dehydration and low blood pressure. Call your heart failure team for instructions. Do not stop or restart treatment on your own.
Kidney disease.
Your kidney function and potassium may need closer follow up, and sometimes a different starting strength.
Surgery or procedures.
Give the team your current heart failure medicine list and blood pressure readings. The anesthesia team should decide the timing around your procedure.
Daily weight.
Weigh yourself at the same time each morning, after urinating and before breakfast, in similar clothing. Follow the specific call threshold from your heart failure clinic, and ask them to write it down.
How Fairview helps Entresto patients
When you fill Entresto at Fairview, here is what you get. This is normal care for us, not something extra.
At your first fill:
- We confirm the medicine, strength, schedule, and treatment purpose.
- We review your other medicines for interactions, especially ACE inhibitors, ARBs, NSAIDs, and potassium products.
- We explain the key safety rule: no ACE inhibitors, and the 36 hour washout when switching.
- We help you build a workable twice daily plan and identify insurance barriers.
At every refill:
- We check for new medicines and ask about side effects.
- We help prevent refill gaps and review lab or appointment needs.
- We reinforce correct use of your tablet or Sprinkle form and look into cost changes.
When something changes:
- We review any new medicine and contact your prescriber when needed.
- We help you prepare medication information for surgery or travel.
- We discuss side effects and counsel an approved caregiver.
Questions people ask about Entresto
No. They must never overlap, and at least 36 hours must separate them. This rule applies to all ACE inhibitors.
Have a question about your Entresto? Ask a pharmacist who knows it well.
The Entresto rule to remember is absolute: never overlap it with an ACE inhibitor, and keep the required 36 hour washout. Take it twice daily, track your weight and breathing, and keep your blood pressure, potassium, and kidney checks. Fairview can compare your medicine list, explain your tablet or Sprinkle form, and help with refills and coverage. Moving your prescription to us takes one phone call.