Sacubitril and valsartan

Easy-to-read medicine information about sacubitril and valsartan – what it is, how to take sacubitril and valsartan safely and possible side effects. Sacubitril and valsartan is also called Entresto®

Type of medicine Also called
  • Combination medicine to treat heart failure (neprilysin inhibitor and ARB)
  • Entresto®

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:

Date Morning Evening
     
     
     
     
Notes:

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.

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.

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.

Side effects What should I do?
  • Nausea (feeling sick) 
  • Vomiting (being sick)
  • Headache
  • Diarrhoea (runny poos)
  • 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
  • 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 the lips, face, and mouth or difficulty breathing
  • Tell your doctor immediately or ring HealthLine 0800 611 116

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
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 16 Oct 2018