Entresto contains a combination of sacubitril and valsartan. Sacubitril is a blood pressure medicine. It works by increasing the levels of certain proteins in the body that can dilate (widen) blood vessels. This helps lower blood pressure by reducing sodium levels. Entresto is primarily used in the management of heart failure with reduced ejection fraction (HFrEF). It is prescribed for patients who have already experienced symptoms of heart failure and whose condition has been stabilized.

Warnings and Precautions

While Entresto can be highly effective, it is crucial to understand the potential risks and precautions involved to ensure its safe and responsible use.

Understanding Heart Failure

Heart failure is a serious condition in which the heart is unable to pump blood efficiently, leading to a range of symptoms and complications. Entresto is specifically designed to address heart failure with reduced ejection fraction, a condition where the heart’s left ventricle does not pump blood effectively. Before considering Entresto, it is essential to undergo a thorough medical evaluation and obtain a proper diagnosis from a qualified healthcare professional.

Medical History and Allergies

Prior to starting Entresto, it is crucial to inform your healthcare provider about your complete medical history, including any existing medical conditions, allergies, and past reactions to medications. Certain medical conditions or allergies may affect the suitability of Entresto for your specific situation. Open and honest communication with your healthcare provider is vital to ensure safe and effective treatment.

Pregnancy and Breastfeeding

If you are pregnant or planning to become pregnant, it is important to discuss the potential risks and benefits of Entresto with your doctor. Entresto may have adverse effects on the developing fetus and should be used with caution during pregnancy. Similarly, breastfeeding mothers should consult their healthcare provider before using Entresto, as it may pass into breast milk and harm the nursing infant.

Kidney and Liver Function

Entresto may affect kidney function, especially in patients with pre-existing kidney problems. Therefore, individuals with impaired kidney function should exercise caution while using Entresto and undergo regular monitoring. Additionally, Entresto can also impact liver function. If you have a history of liver disease or abnormal liver function, it is important to discuss this with your healthcare provider before starting Entresto.

Hypotension and Hyperkalemia

Entresto has the potential to cause low blood pressure (hypotension) and increased potassium levels (hyperkalemia). These effects can lead to symptoms such as dizziness, lightheadedness, and weakness. Your healthcare provider will closely monitor your blood pressure and potassium levels while you are on Entresto. It is crucial to follow their instructions and report any concerning symptoms promptly.

Adverse Reactions and Side Effects

As with any medication, Entresto may cause adverse reactions and side effects in some individuals. Common side effects include dizziness, cough, low blood pressure, and increased potassium levels. It is important to be aware of these potential side effects and promptly report any unusual symptoms to your healthcare provider.

Side Effects

While Entresto can be effective in managing heart failure symptoms, like any medication, it may also have side effects.

Common Side Effects

  • Headache: Headaches are a commonly reported side effect of Entresto. If you experience persistent or severe headaches, it is advisable to consult your healthcare provider.
  • Dizziness: Some individuals may feel dizzy or lightheaded when taking Entresto. It is important to be cautious while standing up or performing activities that require alertness until you know how this medication affects you.
  • Cough: Entresto may cause a persistent cough in some individuals. If the cough becomes bothersome or persists, it is recommended to speak with your doctor.
  • Fatigue: Feeling tired or fatigued is another common side effect of Entresto. If you experience excessive tiredness or if it affects your daily activities, consult your healthcare professional.
  • Nausea: Entresto may cause nausea or an upset stomach in some individuals. Taking the medication with food or as directed by your doctor can help alleviate this side effect.

Rare Side Effects

  • Angioedema: Angioedema is a potentially serious allergic reaction that can cause swelling of the face, lips, tongue, or throat. If you notice any signs of angioedema, such as difficulty breathing or swallowing, seek immediate medical assistance.
  • Hypotension: Entresto may lower blood pressure, leading to hypotension in some individuals. Symptoms of low blood pressure may include dizziness, lightheadedness, or fainting. If you experience these symptoms, consult your healthcare provider.
  • Hyperkalemia: Hyperkalemia refers to an elevated level of potassium in the blood. Entresto can sometimes cause this condition. Symptoms of hyperkalemia may include weakness, fatigue, palpitations, or numbness. Inform your doctor if you experience any of these symptoms.
  • Liver Problems: In rare cases, Entresto may lead to liver problems. If you notice any signs of liver dysfunction, such as yellowing of the skin or eyes, dark urine, or persistent abdominal pain, seek medical attention immediately.

Severe Side Effects

  • Allergic Reactions: Some individuals may develop severe allergic reactions to Entresto. Symptoms may include rash, itching, swelling, severe dizziness, or difficulty breathing. If you experience any signs of an allergic reaction, call emergency services immediately.
  • Kidney Problems: Entresto can, in rare cases, cause kidney problems. Signs of kidney issues may include decreased urination, swelling in the ankles or legs, or changes in urine color. Contact your healthcare provider if you notice any of these symptoms.
  • Fetal Harm: Entresto should not be used during pregnancy as it may cause fetal harm or even death. If you become pregnant while taking Entresto, inform your doctor immediately.
  • Worsening Heart Failure: Although uncommon, Entresto can sometimes worsen heart failure symptoms. If you experience increased shortness of breath, sudden weight gain, or swelling in the extremities, seek medical attention promptly.

While severe side effects associated with Entresto are relatively rare, they can occur and require immediate medical attention.

Drug Interactions

It is important to understand how Entresto interacts with other drugs to ensure safe and effective treatment.

ACE inhibitors

Combining Entresto with ACE inhibitors may increase the risk of angioedema, a serious allergic reaction that can cause swelling of the face, lips, tongue, or throat. It is generally recommended to avoid using ACE inhibitors concurrently with Entresto.


Concurrent use of Entresto with ARBs may increase the risk of hypotension (low blood pressure). Close monitoring of blood pressure is necessary if these medications are used together.

Potassium-Sparing Diuretics

Entresto can increase the levels of potassium in the blood. When combined with potassium-sparing diuretics, such as spironolactone, triamterene, or amiloride, the risk of hyperkalemia (high potassium levels) may further increase. Regular monitoring of potassium levels is essential in such cases.


NSAIDs, including ibuprofen and naproxen, may reduce the effectiveness of Entresto in lowering blood pressure. They can also increase the risk of kidney problems when used with Entresto. It is advisable to consult with a healthcare professional before combining these medications.


Entresto may increase the levels of lithium in the blood, potentially leading to lithium toxicity. Close monitoring of lithium levels is necessary if these medications are used together.


Combining Entresto with digoxin may increase the levels of digoxin in the blood. Regular monitoring of digoxin levels and close observation for signs of toxicity are recommended in such cases.

How To Use

If you or a loved one has been prescribed Entresto, it’s important to understand how to take it correctly to maximize its benefits.

1. Consult with Your Healthcare Provider: Before starting any new medication, it is crucial to consult with your healthcare provider. They will assess your condition, review your medical history, and determine if Entresto is the right choice for you. Your healthcare provider will also provide specific instructions on how to use Entresto based on your individual needs.

2. Follow the Prescribed Dosage: To ensure the effectiveness and safety of Entresto, it is essential to follow the prescribed dosage as instructed by your healthcare provider. Entresto is available in different strengths, and the dosage may vary depending on your condition and response to treatment. Typically, the initial recommended dose is 49/51 mg (sacubitril/valsartan) twice daily, which may be gradually increased to a target maintenance dose of 97/103 mg twice daily.

3. Take Entresto Regularly: Consistency is key when taking Entresto. It is important to take the medication at the same time every day to maintain stable levels in your body. Consider setting a reminder or incorporating it into your daily routine to help you remember to take your dose.

4. Swallow the Tablets Whole: Entresto tablets should be swallowed whole with water and should not be crushed, chewed, or divided. This is important to ensure that the medication is released properly in your body and works as intended.

5. Food and Entresto: Entresto can be taken with or without food. However, it is generally recommended to take it with food to help minimize the risk of potential side effects such as dizziness or lightheadedness.

6. Do Not Stop Taking Entresto Abruptly: If you have been prescribed Entresto, it is crucial not to stop taking the medication abruptly without consulting your healthcare provider. Suddenly discontinuing Entresto can lead to worsening symptoms and potentially serious complications. If you have concerns or experience any side effects, it is important to discuss them with your healthcare provider, who can guide you on the appropriate course of action.

7. Store Entresto Properly: Entresto should be stored at room temperature, away from moisture and heat. Make sure to keep the medication out of reach of children and pets. If you have any expired or unused medication, consult with your pharmacist on the proper disposal methods.


Proper dosing of Entresto is crucial to ensure optimal treatment outcomes and to minimize the risk of potential side effects.

Starting Dose

When initiating Entresto treatment, the recommended starting dose is 49/51 mg (sacubitril/valsartan) twice daily. This dose is appropriate for patients who have been on an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) at a stable dose equivalent to at least 10 mg of enalapril daily. It is important to note that Entresto should not be initiated until 36 hours after the last dose of ACE inhibitor therapy to prevent the risk of angioedema.

Titration of Dose

After starting Entresto, the dose should be increased at regular intervals to achieve the target maintenance dose. The target maintenance dose is 97/103 mg (sacubitril/valsartan) twice daily. The dose should be doubled every 2 to 4 weeks, as tolerated by the patient, until reaching the target maintenance dose. It is crucial to closely monitor patients for signs of hypotension and renal function during the titration period.

Maintenance Dose

Once the target maintenance dose of Entresto is achieved, it should be continued long-term to maximize the benefits. The maintenance dose of 97/103 mg (sacubitril/valsartan) twice daily has been shown to provide significant improvement in clinical outcomes for patients with heart failure. Compliance with the prescribed maintenance dose is essential to ensure consistent therapeutic effects.

Dose Adjustment

In some cases, dose adjustments may be necessary to manage adverse effects or accommodate specific patient populations. For patients who experience hypotension during the titration period, a temporary reduction in the dose or discontinuation of diuretics may be considered. It is important to consult with a healthcare professional to determine the appropriate course of action based on individual patient needs.

Missed Dose

If a dose of Entresto is missed, it should be taken as soon as it is remembered, unless it is close to the time for the next scheduled dose. In such cases, the missed dose should be skipped, and the regular dosing schedule should be resumed. Double dosing should be avoided to prevent potential adverse effects.


An overdose of Entresto can be dangerous and should be avoided. If an overdose is suspected, immediate medical attention should be sought. Symptoms of an overdose may include dizziness, lightheadedness, low blood pressure, and increased heart rate. Treatment for an overdose of Entresto may involve supportive care and measures to stabilize blood pressure and heart function.


As with any medication, proper storage is essential to maintain its effectiveness and safety. Entresto should be stored in a cool and dry place, away from direct sunlight, moisture, and extreme temperatures.

  • Storing Entresto at Room Temperature: It is generally recommended to store Entresto at room temperature, which typically ranges between 68°F (20°C) and 77°F (25°C). This temperature range provides optimal conditions for maintaining the stability of the medication. Keep the Entresto tablets in their original packaging until ready to use.
  • Avoiding Exposure to Moisture: Moisture can degrade the quality of Entresto tablets, so it’s important to protect them from exposure. Store the medication in a dry place, and avoid storing it in the bathroom or near sinks. Additionally, refrain from opening the packaging until you’re ready to take a dose.
  • Protecting Entresto from Light: Light can also have a detrimental effect on the stability of Entresto. Keep the medication away from direct sunlight and sources of intense light. Storing it in a dark, opaque container or cabinet can help shield it from unnecessary light exposure.
  • Avoiding Extreme Temperatures: Extreme temperatures, both hot and cold, can impact the potency and effectiveness of Entresto. Keep the medication away from heat sources such as radiators, stoves, or direct sunlight. Similarly, avoid storing it in freezing temperatures, such as the freezer or refrigerator.
  • Keep Out of Reach of Children and Pets: To ensure the safety of your loved ones, it’s crucial to store Entresto in a secure location, out of the reach of children and pets. Consider using a lockable medicine cabinet or a high shelf to prevent accidental ingestion.


Proper disposal of medications is crucial to protect the environment and ensure the safety of others.

  1. Check for Take-Back Programs: Many communities and pharmacies have take-back programs specifically designed for the safe disposal of medications. These programs allow you to return unused or expired medications, including Entresto, for proper disposal. Check with your local pharmacy or search online for take-back programs in your area.
  2. Follow FDA Guidelines: If no take-back program is available, the FDA provides guidelines for the safe disposal of medications. Start by removing Entresto from its original packaging and mixing it with an undesirable substance such as dirt, coffee grounds, or cat litter. This helps prevent accidental ingestion and makes the medication less appealing to pets or children.
  3. Place in Sealed Container: Put the mixture of Entresto and the undesirable substance into a sealable bag or container. Ensure that the container is tightly closed to prevent leakage.
  4. Dispose in Household Trash: Now that you have securely packaged the mixture, you can safely dispose of it in your household trash. However, it’s important to keep in mind that some states have specific regulations regarding medication disposal. Check your local regulations to ensure compliance with any state-specific guidelines.
  5. Remove Personal Information: Before discarding the original packaging, remember to remove any personal information that may be on the label. This will help protect your privacy and prevent unauthorized access to your personal details.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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