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EspañolEntresto is a combination prescription tablet taken twice daily to reduce the risk of cardiovascular death or hospitalization in people with chronic heart failure. Entresto is especially effective in treating heart failure involving a lowered ejection fraction, that is, the lower part of the heart does not pump a normal amount of blood.
Entresto is the sole member of a class of drugs called angiotensin receptor neprilysin inhibitors. Entresto’s two ingredients—sacubitril/valsartan—include an angiotensin II receptor blocker (valsartan), commonly used to treat high blood pressure, and a neprilysin inhibitor (sacubitril). Both cause blood vessels to widen, increasing blood flow and reducing blood pressure. High blood pressure and reduced blood flow both contribute to the degenerative process of congestive heart failure, so bringing them under control helps to prolong survival. Entresto is often prescribed along with other heart failure medications such as a beta-blocker, a type of drug that relaxes the heart muscles.
RELATED: Learn more about Entresto | Get Entresto discounts
Entresto forms and strengths
Entresto comes in three strengths. Doses are indicated by the amount of each ingredient in a tablet. However, a patient may notice the ingredient strengths combined into a single number, particularly if the tablets are mixed into an oral solution. Tablet strength below includes the standard two-number strength and the equivalent single-number strength.
Tablets: 24 milligrams (mg) of sacubitril/26 mg of valsartan (50 mg total), 49/51 mg (100 mg total), 97/103 mg (200 mg total)
Entresto dosage for adults
Entresto will be initially prescribed at a low dose and titrated (steadily increased) to the standard recommended dose of 97/103 mg (200 mg) taken twice per day. The goal is to determine if the patient can tolerate the drug without any serious side effects such as angioedema (swelling underneath the skin usually in the face or throat). The initiation period usually lasts two to four weeks after which the dose will be doubled until the standard dose is reached. People with moderate liver dysfunction, with severe renal disease, who have been taking lower doses of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), or who have never taken ACE inhibitors or ARBs will be started on the lowest possible dose.
It’s important for patients to remember that if they currently take an ACE inhibitor or an ARB, this medication will be discontinued before starting Entresto. If people are switching from an ACE inhibitor (for example lisinopril, enalapril, or benazepril) to Entresto, there must be a washout period (when medication is not taken) for 36 hours between the two medications.
| Entresto dosage chart | |||
|---|---|---|---|
| Indication | Starting dosage | Standard dosage | Maximum dosage |
| Chronic heart failure | Adults converting from normal doses of ACE inhibitors or ARBs | ||
| 49/51 mg tablet taken twice per day for 2-4 weeks | 97/103 mg tablet taken twice per day | Not specified | |
| Adults converting from low or no previous doses of ACE inhibitors or ARBs | |||
| 24/26 mg tablet taken twice per day for 2-4 weeks followed by 49/51 mg tablet taken twice per day for another 2-4 weeks | 97/103 mg tablet taken twice per day | Not specified | |
| Adults with severe renal disease or moderate liver dysfunction converting from normal doses of ACE inhibitors or ARBs | |||
| 24/26 mg tablet taken twice per day for 2-4 weeks followed by 49/51 mg tablet taken twice per day for another 2-4 weeks | 97/103 mg tablet taken twice per day | Not specified | |
Entresto dosage for children
Entresto is FDA-approved to prolong survival in children with symptomatic heart failure (NYHA Class II–IV) who are one year or older. The dose of Entresto will depend on the child’s weight. As with adults, the dose will be titrated to the final standard dose. Initial doses will be lower in children not already on normal doses of ACE inhibitors or ARBs. Children with liver or kidney problems will also be started at the lowest possible dose. The manufacturer of Entresto states the oral suspension is recommended in children instead of tablets. This recommendation is also useful for children with difficulty swallowing tablets, and a healthcare provider can prepare a 4 mg/mL concentration (1.96 sacubitril/2.04 valsartan mg/mL) oral suspension that can be given with a dosing syringe.
| Entresto pediatric dosage by weight | ||
|---|---|---|
| Weight | Starting dosage | Recommended dosage |
| Children converting from normal doses of ACE inhibitors or ARBs | ||
| < 40 kg | 1.6 mg/kg* twice daily for 2 weeks and then increased to 2.3 mg/kg twice daily for another 2 weeks | 3.1 mg/kg twice daily |
| 40–50 kg | 24/26 mg twice daily for 2 weeks and then increased to 49/51 mg twice daily for another 2 weeks | 72/78 mg twice daily |
| > 50 kg | 49/51 mg twice daily for 2 weeks and then increased to 72/78 mg twice daily for another 2 weeks | 97/103 mg twice daily |
| Children converting from low or no previous doses of ACE inhibitors or ARBs | ||
| < 40 kg | 0.8 mg/kg twice daily for 2 weeks and then increased to 1.6 mg/kg twice daily for 2 weeks and then increased to 2.3 mg/kg twice daily for another 2 weeks | 3.1 mg/kg twice daily |
| 40–50 kg | 0.8 mg/kg twice daily for 2 weeks and then increased to 24/26 mg twice daily for 2 weeks and then increased to 49/51 mg twice daily for another 2 weeks | 72/78 mg twice daily |
| > 50 kg | 24/26 mg twice daily for 2 weeks and then increased to 49/51 mg twice daily for 2 weeks and then increased to 72/78 mg twice daily for another 2 weeks | 97/103 mg twice daily |
* 1 kg = 2.2 lbs
Entresto dosage restrictions
Some people will require a starting dose adjustment, but the starting dose will eventually be titrated to a standard dose. People with moderate to severe kidney impairment (eGFR <30) or moderate hepatic impairment (Child-Pugh Class B hepatic impairment) will be started at lower doses than others, but adults and children with severe liver problems should not take Entresto. During the titration period, doses will increase every two to four weeks until the standard adult or pediatric dose is reached.
People with severe renal impairment are at risk for acute renal failure when taking Entresto. They may be given Entresto, but the initial dose will be reduced. Pregnant women, nursing mothers, and people who have an allergic reaction or other adverse reactions to Entresto will not be given Entresto. As soon as pregnancy is identified in women, Entresto should immediately be discontinued because it can cause toxicity to the fetus.
Entresto dosage for pets
Entresto has recently been studied for use in animals, especially dogs, to treat dogs with heart failure. However, pets with heart failure are more likely to be prescribed an ACE inhibitor, ARB, diuretic (such as spironolactone or furosemide), or pimobendan, a veterinary drug that relaxes the heart and widens blood vessels in dogs and cats. At least two recent clinical studies have demonstrated Entresto’s effectiveness in treating dogs with heart failure, but more research needs to be done. As with humans, Entresto is administered to dogs orally twice a day, but there are no dosage standards.
How to take Entresto
Entresto is taken as a coated tablet twice per day with or without food. For young children or people unable to swallow a tablet, a doctor, pharmacist, or other healthcare professional can prepare an oral solution for easier administration.
Take the medicine as directed
Read and follow the patient instructions that come with this medicine
Store Entresto at room temperature away from light or heat
Do not store the oral suspension in a refrigerator
Dispose of any unused oral suspension that is not used within 15 days of its mixing
Tablets
Swallow the tablet whole with a glass of water
Oral solution
Shake the oral solution well before measuring out a dose
Use a metered dosing syringe or another dose-measuring device to measure out the liquid. Do not use kitchen spoons, cups, measuring spoons, or measuring cups.
Swallow the full measured dose
Entresto dosage FAQs
How long does it take Entresto to work?
Entresto is intended as long-term therapy to reduce the likelihood of hospitalization or death in people with heart failure. The goal of therapy is to reach and maintain a steady-state concentration of the two active ingredients in the bloodstream. Steady-state is when the amount of medication in the body is at a therapeutic amount and is achieved after about three days of a person taking Entresto.
How long does Entresto stay in your system?
Entresto combines two drugs that both help to lower blood pressure and increase blood flow, but get cleared from the body at different rates. Sacubitril is an inactive drug that converts into an active form in the body. This active form is highest at 2 hours after taking Entresto and is 50% eliminated after about 12 hours. Valsartan is highest at about 1 to 2 hours after taking Entresto and is 50% eliminated after about 10 hours.
What happens if I miss a dose of Entresto?
Take a missed dose as soon as it’s remembered, but don’t take it if it's close to the next scheduled dose. In that case, wait and take the next dose. Do not take extra medicine or two doses to make up for a missed dose.
Can you overdose on Entresto?
Neither of the active ingredients in Entresto are toxic, but an overdose could cause blood pressure to drop very low, a potentially hazardous condition called hypotension. If an overdose is suspected, seek emergency medical care.
What interacts with Entresto?
Because of possible drug interactions, Entresto should not be taken with certain types of prescription and over-the-counter (OTC) medications. In particular, the concomitant use of ACE inhibitors, blood pressure medications that work in much the same way as valsartan, is forbidden. If a patient is already on ACE inhibitor therapy (such as enalapril or lisinopril), a washout period of at least 36 hours is required before starting Entresto because of the risk of angioedema (swelling) and other adverse effects.
Entresto affects the delicate hormonal system that governs both blood pressure and how kidneys filter water and salts from the body. Called the renin-angiotensin-aldosterone system (RAAS), drugs like valsartan work to block receptors in this system. Another contraindication includes aliskiren, a drug that also blocks RAAS, and is never given along with Entresto. Angiotensin II receptor blockers, or ARBs (which include valsartan), also block this system, so ARB therapy is generally avoided when taking Entresto.
Other drugs that should be avoided include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and COX-2 inhibitors—both of which risk acute renal failure in people taking Entresto. This is especially important for elderly patients, people with depleted volume, or with decreased kidney function. Lithium should be used cautiously in people taking Entresto because the levels of lithium in the body could be toxic. Using potassium supplements, salt substitutes, or potassium-sparing diuretics along with Entresto raises the risk of a potentially hazardous increase in serum potassium. High potassium (hyperkalemia) is a potentially dangerous condition, so these should be avoided or used with care.
What happens when you mix Entresto and alcohol?
Drinking alcohol does not need to be avoided when taking Entresto. However, alcohol use can increase blood pressure. This includes a temporary increase in blood pressure with a single drink or developing chronic hypertension with regular long-term drinking of alcohol. Because alcohol can affect the body’s blood pressure, people taking Entresto should discuss their alcohol use with their healthcare provider to determine the appropriate amount for them. In addition, moderate to heavy alcohol use can reduce the heart’s ability to pump blood in patients with chronic heart failure with reduced left ventricular ejection fraction (LVEF), the medical condition Entresto is most commonly used for. For people with CHF with LVEF, avoiding or cutting back on alcohol may be part of their treatment plan with their doctor.
Is it safe to take Entresto during pregnancy?
Entresto has a black box warning regarding pregnancy. The use of Entresto can harm unborn babies, so it should never be taken during pregnancy because of fetal toxicity. When taken during the second and third trimesters of pregnancy, changes in the RAAS can affect the baby’s renal function and sometimes cause the death of a fetus or newborn.
It is not known if valsartan or sacubitril are present in breast milk during lactation. If they are, they could upset the RAAS in a baby, damaging the kidneys. The manufacturer, Novartis, suggests that nursing mothers either switch medications or discontinue breastfeeding.
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