Entresto side effects and how to avoid them

Entresto is a brand-name prescription drug manufactured by Novartis Pharmaceuticals to treat heart failure. It is a single product containing two medications: sacubitril and valsartan. Sacubitril belongs to a group of drugs called neprilysin inhibitors used to control blood volume and lower blood pressure. Valsartan belongs to a class of drugs called angiotensin II receptor antagonists, used to relax blood vessels. Entresto can cause adverse reactions like any other drug. Learn more about the side effects of Entresto and how to avoid them.

What is Entresto?

Entresto is a prescription medication. 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 other angiotensin II receptor blockers (ARBs).

Entresto active ingredients

Entresto has two active ingredients that work in combination, sacubitril/valsartan. Sacubitril stops an enzyme called neprilysin from breaking down peptides that lower blood pressure. Valsartan reduces blood vessel tightening and the build-up 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 of Entresto is normally 49 mg of sacubitril and 51 mg tablet 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 showed superior efficacy in reducing heart failure hospitalizations, and cardiovascular death, and improving quality of life with comparable safety and tolerability vs enalapril ACE inhibitor.

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Entresto common side effects

Common possible side effects include:

  • Dizziness or feeling lightheaded
  • 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
  • Swelling of your face, lips, tongue, and throat (angioedema) that may cause trouble breathing and death. People who are black and take Entresto may have a higher risk of having angioedema than people who are not black and take Entresto.
  • Severe allergic reactions to the medication that causes trouble 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)

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Entresto drug interactions

Entresto can interact with other medications, including:

  • Any angiotensin medications, like angiotensin-converting enzyme (ACE) inhibitors such as lisinopril, captopril, benazepril, ramipril, quinapril, or angiotensin receptor blockers (ARBs) such as candesartan, or losartan
  • Any other medications taken to treat heart failure
  • Any other medications taken to treat other heart conditions
  • Any medications for high blood pressure
  • Any medications or supplements that can increase the level of potassium in your blood, like potassium supplements, salt substitutes containing potassium, potassium-sparing diuretics, 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 (water pills)
  • 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 or kidney disease
  • Have any liver problems or liver disease
  • Have a history of hereditary angioedema
  • Are breastfeeding or are planning to breastfeed. It is not known if sacubitril/valsartan is present in human breast milk.

How to avoid Entresto side effects

While completely avoiding Entresto side effects may not be possible, there are some things you can do to reduce their severity:

1. Stick to the recommended dosage

Take your prescribed dose that has been recommended by your healthcare professional. It is typically taken twice a day, at the same time each day. Entresto can be taken with or without food. Sticking to the same timings and taking your medication consistently will make a big difference in how well Entresto works for you.

If you miss a dose of this medicine, skip the missed dose and take the next dose as scheduled. Using reminders or setting alarms on your phone may be helpful if missing doses is a problem. Refer to the medication guide for more drug information.

2. Store Entresto correctly

Entresto should be stored at room temperature in a dry place in its original container. Knowing how to properly store your medication is important to make sure it remains as effective as possible. Taking expired or improperly stored medication could result in the medication not working properly and may even cause unwanted side effects.

3. Discuss medical history

Discussing your medical history with your healthcare provider is important to help them understand how well Entresto will work for you. Give them 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 allow them to pick up any drug interactions with Entresto that may increase possible side effects.

4. Keep hydrated

The active ingredient valsartan in Entresto can cause problems with elevated potassium levels and low blood pressure. Due to this, it’s important to stay hydrated and keep body fluids normal. Work with your healthcare professional to maintain hydration. Watch for signs of elevated potassium such as heart palpitations, weakness, and chest pain.

5. Stay active

The more you move, the better. Exercise has been shown to help improve heart health and staying active can be an easy way for people of all ages or backgrounds to improve their well-being. It’s also worth checking in with your doctor before starting any new physical activity plan because some activities may not work well with certain pre-existing medical conditions.

6. Pay attention to your body

Paying attention to how your body feels when taking Entresto is important, paying particular attention to low blood pressure as it is the most common side effect of Entresto. Seek medical attention for any sign of low blood pressure such as lightheadedness, dizziness, or fainting.

It is important to take notice of new heart failure symptoms or changes to current ones. Some symptoms that go unnoticed at times are shortness of breath, swelling, coughing, confusion or memory loss and rapid weight gain.

Talk to your doctor straight away if you start to experience any side effects of Entresto when taking it. Always seek medical advice if you are concerned about your medication.

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 (3)

  1. Entresto official manufacturer website

  2. Entresto prescribing information

  3. Entresto (Sacubitril/Valsartan): First-in-Class Angiotensin Receptor Neprilysin Inhibitor FDA Approved for Patients with Heart Failure.

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.