Sacubitril and valsartan

What is Entresto?

Entresto is used to treat some types of heart failure. Heart failure occurs when the heart is weak and cannot pump enough blood to the lungs and the rest of the body.  Entresto is usually used with other heart failure therapies, in place of an ACE inhibitor or other ARB therapy. Entresto is made up of 2 medicines (sacubitril and valsartan) in a single tablet. Read more about heart failure.

Dose

In New Zealand, there are 3 strengths of Entresto tablets:

• sacubitril 24.3 mg + valsartan 25.7 mg
• sacubitril 48.6 mg + valsartan 51.4 mg
• sacubitril 97.2 mg + valsartan 102.8 mg

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. You will be started on a low dose and it will be adjusted depending on your response to treatment.
• Know what dose you should be taking — use the dose table below to keep track of changes to your dose.
• 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.

My dose is:

How to take Entresto

• Swallow your Entresto tablets whole with a glass of water.
• Do not crush, chew or break the tablets.
• You can take your Entresto tablets with or without food. 
• Entresto tablets are best taken about the same time each day.
• 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 your Entresto tablets for the full time it has been prescribed, even if you feel well. 

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, quinapril. Read more about ACE inhibitors.

• 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.

Precautions - while you are taking Entresto

• Avoid taking NSAIDs (anti-inflammatory pain relief medication). 
  The combination of Entresto with NSAIDs (anti-inflammatory pain relief medication) can be very harmful to your kidneys. It can cause acute kidney injury. Examples of commonly used NSAIDs are ibuprofen, diclofenac, naproxen and celecoxib. Read more about NSAIDs. 
• Avoid taking potassium supplements, check with your pharmacist first.
• Let your doctor know if you have been sick with diarrhoea or vomiting – these things can cause dehydration and it is important to keep well hydrated while taking Entresto. 

Possible side effects

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.

Interactions

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

Learn more

Entresto Medsafe Consumer Information Sheet

References

1. Sacubitril + valsartan New Zealand Formulary 
2. Entresto datasheet Medsafe, NZ