Entresto

Entresto is used to treat heart failure (weak heart pump). Find out how to take Entresto safely and possible side effects. Entresto is also called sacubitril and valsartan.

What is Entresto?

Entresto is used to treat some types of heart failure. Heart failure occurs when your heart is weak and cannot pump enough blood to your lungs and the rest of your body. The most common symptoms of heart failure are breathlessness, fatigue, tiredness and ankle swelling. Entresto relaxes your blood vessels and reduces excess fluid in your body, which makes it easier for your heart to pump blood around your body. Read more about heart failure.

Dose

Entresto is made up of 2 medicines (sacubitril and valsartan) as a combination in each tablet. In New Zealand, there are 3 strengths of Entresto tablets. Check with your pharmacist which strength you are taking.

Entresto 24/26
 Entresto 49/51 Entresto 97/103

Sacubitril 24.3 mg +

valsartan 25.7 mg

Sacubitril 48.6 mg +

valsartan 51.4 mg

Sacubitril 97.2 mg +

valsartan 102.8mg
  • The dose of Entresto is 1 tablet twice daily.
  • Your doctor will decide your starting dose based on which medicines you have been taking before.
  • The dose may be adjusted depending on your response to treatment.
  • Always take your Entresto exactly as your doctor has told you.
  • The pharmacy label on your medicine will tell you how much Entresto to take, how often to take it and any special instructions.

How to take Entresto

  • Timing: Take your Entresto tablets 2 times a day – one tablet in the morning and one tablet in the evening. You can take Entresto with or without food. Take your tablets about the same time each day.
  • Swallow your tablet whole with a glass of water. Do not crush, chew or break the tablets.
  • Missed dose: If you forget to take your dose of Entresto, take it as soon as you remember. But if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
  • Keep taking Entresto regularly. Stopping your treatment with Entresto may cause your heart failure to get worse. Do not stop taking your Entresto unless your doctor tells you to.

Precautions before starting Entresto

Are you pregnant or planning a pregnancy? 
Entresto should be avoided at all stages of pregnancy.

Are you taking an ACE inhibitor?
Entresto must not be taken with an ACE inhibitor. If you are being changed from an ACE inhibitor to Entresto, wait at least 36 hours after your last dose, then start Entresto. Examples of ACE inhibitors include captopril, cilazapril, enalapril, lisinopril, perindopril and quinapril. Read more about ACE inhibitors.

Are you taking an ARB?
Entresto must not be taken with an ARB (angiotensin receptor blocker). You must stop your ARB before starting Entresto. Examples of ARBs include candesartan, losartan and irbesartan. Read more about ARBs.

Other precautions

  • Are you breastfeeding?
  • Have you had allergic reactions with swelling of your lips, eyes or tongue (called angioedema)?
  • Do you have problems with your liver?
  • Do you have diabetes?
  • Do you have kidney disease such as renal artery stenosis?
  • Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines?

If so, it’s important that you tell your doctor or pharmacist before you start Entresto. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What are the side effects of sacubitril and valsartan?

Like all medicines, Entresto can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Nausea (feeling sick) 
  • Vomiting (being sick)
  • Headache
  • Diarrhoea (runny poo)
  • Stomach pain
  • These are quite common when you first start taking Entresto and usually get better with time.
  • Tell your doctor if troublesome or if you have been vomiting.
  • Dizziness, feeling faint or lightheaded
  • Dizziness is quite common when you first start taking Entresto.
  • Be careful as you are at increased risk of falls, especially when you stand up from sitting or lying down.
  • Get up slowly out of bed or stand up slowly. Take a few minutes to sit on your bed or on a chair first.
  • The dizziness goes away after a while. If the dizziness is severe or ongoing, tell your doctor.
  • Cough
  • Tiredness
  • Tell your doctor if troublesome.
  • Signs of an allergic reaction such as skin rash, itching, swelling of your lips, face, and mouth, or difficulty breathing
  • Tell your doctor immediately or phone Healthline 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product

Interactions with other medicines

Entresto may interact with other medicines and herbal supplements, so check with your doctor or pharmacist before starting Entresto and before starting any new medicines.

Don't take NSAIDs (anti-inflammatory pain relief medication) unless you have spoken to your doctor or pharmacist.
The combination of Entresto with NSAIDs can worsen your heart failure and is harmful to your kidneys.  Examples of commonly used NSAIDs are:
  • ibuprofen (eg, Nurofen)
  • diclofenac (eg, Voltaren)
  • naproxen
  • celecoxib.

Some of these medicines can be found in cough and cold preparations. Read more about NSAIDs. 

Learn more

Entresto Medsafe Consumer Information Sheet, NZ

References

  1. Sacubitril + valsartan NZ Formulary 
  2. Entresto datasheet Medsafe, NZ
Credits: Sandra Ponen, Pharmacist. Reviewed By: Johanna Lim, Cardiology Pharmacist, North Shore Hospital, Waitemata DHB; Maya Patel, Pharmacist, Auckland Last reviewed: 10 Sep 2021