Entresto alternatives: which other heart medications can I take?

Entresto is a combination of two drugs a neprilysin inhibitor and an angiotensin II receptor blocker (ARB) used for the treatment of heart failure. Entresto is the only drug in the angiotensin receptor-neprilysin inhibitor (ARNI) class so there are no alternatives in the same drug class but there are many other alternatives to look at. You may be considering alternative medications due to cost as Entresto is currently only available as a brand-name drug. Even with insurance or Medicare, it is an expensive treatment option. Read on to find out more.

What is Entresto?

Entresto is a prescription medication manufactured by Novartis Pharmaceuticals to treat heart failure. It’s prescribed to:

  • Reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and heart failure with reduced ejection fraction (HFrEF)
  • Treat heart failure in children one year and older

Heart failure, also called congestive heart failure or cardiac failure results in high rates of morbidity and mortality. It occurs when your heart still beats but can’t pump enough blood around your body. This can reduce how much oxygen your organs receive, which can make it harder for them to function and can cause damage. Treatments for heart failure depend on the severity of your condition.

Entresto comes as an oral tablet. It helps to lower your blood pressure, making it easier to pump blood around your body. The medication is usually prescribed instead of other angiotensin medications, like angiotensin-converting enzyme (ACE) inhibitors or another angiotensin II receptor blockers (ARBs).

Entresto active ingredients

Entresto has two active ingredients that work in combination, called sacubitril/valsartan. Sacubitril stops an enzyme called neprilysin from breaking down peptides that lower blood pressure. Valsartan reduces blood vessel tightening and the buildup of sodium and fluid. Both drugs make it easier for your heart to pump blood around your body.

Entresto dosage

Entresto is available in three tablet strengths:

  • 24/26 mg (sacubitril 24 mg and valsartan 26 mg)
  • 49/51 mg (sacubitril 49 mg and valsartan 51 mg)
  • 97/103 mg (sacubitril 97 mg and valsartan 103 mg)

Entresto is also available in an oral suspension. It can be substituted at the recommended tablet dosage in patients unable to swallow tablets. The starting dose is normally 49 mg of sacubitril and 51 mg of valsartan twice daily. The low dose is used in patient groups who are not currently taking an ACE inhibitor or an angiotensin II receptor blocker, patients with severe renal impairment, and patients with moderate hepatic impairment.

How effective is Entresto?

The FDA approval of Entresto was gained from the results of the PARADIGM-HF clinical trial involving 8442 heart failure patients. The aim of the study was to determine whether treatment with Entresto was superior to enalapril.

Entresto side effects

Common possible side effects include:

  • Dizziness
  • Cough
  • Headaches
  • Tiredness and weakness
  • Fainting
  • Diarrhea
  • Feeling sick (nausea)
  • Stomach pain (gastritis)

Entresto can cause more serious side effects, including:

  • Causing harm or death to your unborn baby
  • Severe allergic reactions to the medication that cause problems with breathing and death
  • Kidney problems, including reduced kidney function and kidney failure
  • Low blood pressure (hypotension), particularly if you also take diuretic medications
  • High potassium levels in your blood (hyperkalemia)

Entresto drug interactions

Entresto can interact with other medications, including:

  • Any angiotensin medications, like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
  • Any other medications taken to treat heart failure
  • Any other medications taken to treat other heart conditions
  • Any medications that lower your blood pressure
  • Any medications or supplements that can increase the amount of potassium in your blood, like potassium supplements, salt substitutes containing potassium, potassium-sparing medicines, or heparin
  • Any medications taken to treat diabetes, particularly ones that contain aliskiren
  • Any pain killers, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
  • Any diuretic medications
  • Any antibiotics
  • Sildenafil (Viagra), used to treat erectile dysfunction or lung hypertension
  • Lithium, taken to treat some psychiatric disorders

Entresto warnings & precautions

Entresto can cause harm or death to your unborn baby. Don’t take Entresto if you’re pregnant. Talk to your doctor if you plan to become pregnant or do become pregnant while taking Entresto. This drug acts on the renin-angiotensin-aldosterone system therefore should be abruptly discontinued once pregnancy is confirmed.

Entresto should not be given to children under one year of age.

Entresto can cause side effects, like dizziness, that can affect your ability to drive, use machinery, or perform other dangerous tasks. Avoid doing so until you’re confident Entresto doesn’t affect your ability to perform these activities.

Don’t take Entresto if you:

  • Are pregnant or are planning to become pregnant
  • Are allergic to the active ingredients sacubitril or valsartan
  • Are allergic to any of the other ingredients in Entresto
  • Have ever had an allergic reaction to an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) medication
  • Are currently taking an angiotensin-converting enzyme (ACE) inhibitor medication
  • Take a diabetes medicine that contains aliskiren

Talk to your doctor before taking Entresto if you:

  • Have any kidney problems
  • Have any liver problems
  • Have a history of hereditary angioedema
  • Are breastfeeding or are planning to breastfeed

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Entresto alternatives

Patients with heart failure have many types of drugs available to help with symptoms and improve reduction in cardiovascular death. Multiple drugs to treat the condition are often taken by patients.

Always seek medical advice from your healthcare provider when looking to change medication. They can provide you with up-to-date drug information and guidelines from the American College of Cardiology and the American Heart Association to work out the best treatment for you. Below are some alternatives to Entresto.


Vasotec is the brand name of enalapril an angiotensin-converting enzyme inhibitor (ACE inhibitor) indicated for the:

  • Treatment of hypertension (high blood pressure) in adults and children older than one month, to help lower blood pressure. Lowering blood pressure reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions
  • Treatment of symptomatic congestive heart failure
  • Treatment of asymptomatic left ventricular dysfunction, to decrease the rate of development of overt heart failure and reduce hospitalization for heart failure

See the full prescribing information for the complete boxed warning. When pregnancy is detected, discontinue treatment as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.


BiDil is a heart failure medicine prescribed to self-identified African American patients. It contains the active ingredients isosorbide dinitrate and hydralazine. It is the only heart failure medicine specifically indicated for self-identified African American patients. You take BiDil as an oral tablet, usually three times a day, but your doctor will tell you how much BiDil to take and how often. BiDil can be used alone or alongside other heart failure medications.

The medication helps treat your heart failure by opening up your blood vessels and reducing your blood pressure, making it easier for your heart to pump blood around your body. This can reduce your chances of needing to be hospitalized and can help you live with your condition more easily and for longer.


Coreg is the brand name product of the active ingredient carvedilol. Carvedilol is a beta-blocker used to treat high blood pressure and help prevent heart disease, heart attacks, and strokes. It is given with other medicines, generally diuretics to treat heart failure. Carvedilol works by slowing down your heart rate, therefore, making it easier for blood to pump around the body. It is available in four different doses, 3.125mg, 6.25mg, 12.5mg and 25mg. The dose depends on the condition you are treating. For heart failure patients 3.125mg twice a day for 2 weeks. The dose will then slowly increase on advice from your doctor.


Spironolactone is an aldosterone antagonist that works on the kidneys to increase the elimination of water and sodium, helping to lower blood pressure. This process results in an increase in potassium in the blood which can be dangerous if not monitored closely.

Aldactone is the brand name of spironolactone and it is indicated for the treatment of NYHA Class III-IV heart failure and reduced ejection fraction to increase survival, manage edema, and reduce the need for hospitalization for heart failure. This drug is usually administered in conjunction with other heart failure therapies.


Diovan is the brand name of valsartan an angiotensin receptor blocker (ARB) that relaxes and widens your blood vessels lowering your blood pressure. The usual dose for heart failure patients is 40mg-160mg twice daily but the dosage will be determined by your doctor. Valsartan is one of the drugs present in Entresto.

What to do if you want to switch to an alternative

Your doctor will advise you on the safest way to stop taking Entresto and then how to start a new drug. Suddenly stopping Entresto may have a worsening effect therefore always follow your doctor’s guidelines. If your doctor decides an ACE inhibitor is suitable for you then a 36-hour elimination time is needed between the last dose of Entresto and the first dose of the ACE inhibitor. This is required to minimize dangerous levels of angioedema.

Discussing your medical history with your prescribing healthcare provider is important to help them understand which alternative will work for you. Some drugs have dangerous drug interactions and must be avoided. Give a complete list of all the prescription drugs, including over-the-counter meds, supplements, and medical conditions you may have. Talking with your doctor will also allow them to pick up any drug interactions that may increase possible side effects.

Medically reviewed

A medical professional has reviewed this article.

Jamie Winn, PharmD
Jamie Winn, PharmD

Jamie Winn, PharmD

Medical Writer & Reviewer

Jamie Winn, PharmD

Medical Writer & Reviewer

Dr. Jamie Winn received his Doctor of Pharmacy in 2002 from the University of South Carolina College of Pharmacy, Columbia, SC. Jamie is a medical reviewer for NiceRx.

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Sources (7)

  1. National library of medicine - Entresto (Sacubitril/Valsartan): First-in-Class Angiotensin Receptor Neprilysin Inhibitor FDA Approved for Patients with Heart Failure

  2. Entresto - official manufacturer website

  3. AHA-ASA Journals - 2013 ACCF/AHA Guideline for the Management of Heart Failure

  4. Medlineplus.gov - Carvedilol

  5. FDA - highlights of prescribing information for Aldactone

  6. FDA - highlights of prescribing information for Bidil

  7. FDA - highlights of prescribing information for Diovan

The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.