Entresto is a prescription medication used to treat heart failure with reduced ejection fraction (HFrEF). It is a combination of two active ingredients: sacubitril and valsartan.

Entresto works through two mechanisms: neprilysin inhibition and ARB activity. By inhibiting neprilysin, it increases the levels of beneficial vasodilatory and sodium excretion-promoting substances in the body, leading to improved cardiovascular function. Additionally, valsartan blocks the effects of angiotensin II, a hormone that constricts blood vessels and increases blood pressure, thereby reducing the strain on the heart and improving its pumping ability.

Precautions and Warnings with Entresto

  • Hypotension: Entresto can cause symptomatic hypotension, particularly in patients with volume depletion or those receiving concomitant diuretic therapy.
  • Renal Impairment: Entresto may cause renal impairment, especially in patients with pre-existing renal disease or those receiving concomitant diuretic therapy.
  • Hyperkalemia: Entresto may increase serum potassium levels.
  • Angioedema: Angioedema, including swelling of the face, lips, tongue, and throat, has been reported with Entresto.
  • Fetal Toxicity: Entresto can cause fetal harm when administered to pregnant women.
  • Hepatic Impairment: Entresto should be used with caution in patients with hepatic impairment.
  • Hypersensitivity Reactions: Hypersensitivity reactions, including rash, pruritus, and anaphylactic reactions, have been reported with Entresto.

Entresto Side Effects

While Entresto is generally well-tolerated, like any medication, it may cause side effects in some individuals. Side effects associated with Entresto may include:

Common Side Effects

  • Cough
  • Dizziness

Serious Side Effects

  • Kidney problems, such as kidney failure. Symptoms can include:
    • Producing a small amount of urine
    • Dark-colored urine
    • Swelling in the feet and legs
    • Confusion
    • Itchy skin
  • Hyperkalemia (high level of potassium in the blood). Symptoms can include:
    • Heart rhythm problems
    • Slow heart rate
    • Muscle weakness
    • Trouble breathing
    • Nausea
  • Severe allergic reaction
  • Hypotension (low blood pressure)
  • Fetal toxicity (fetal harm)

Drug Interactions with Entresto

Entresto may interact with other medications, supplements, or substances, potentially affecting its effectiveness or increasing the risk of adverse effects. Some notable drug interactions with Entresto may include:

  • Potassium supplements or a salt substitute
  • Lithium
  • Other medicines for high blood pressure or heart problems, such as an ACE inhibitor, ARB, or aliskiren
  • A diuretic or “water pill”
  • Nsaids (nonsteroidal anti-inflammatory drugs) – aspirin, ibuprofen (advil, motrin), naproxen (aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

Entresto Strengths and Dosages

Always follow the guidance of your prescriber when it comes to any medication you are taking. Follow their dosage and instructions as they are prescribed to you.

Available Strengths

  • Sacubitril/Valsartan 24 mg/26 mg
  • Sacubitril/Valsartan 49 mg/51 mg
  • Sacubitril/Valsartan 97 mg/103 mg

Recommended Dosages

The recommended starting dose of Entresto is Sacubitril/Valsartan 49 mg/51 mg twice daily. Patients should be titrated to the target maintenance dose of 97 mg/103 mg twice daily, as tolerated by the individual patient.

Administration Instructions

  • Entresto tablets should be taken orally with or without food.
  • Tablets should not be crushed or divided.
  • Patients should be instructed to take Entresto regularly at the same time each day to maintain therapeutic levels in the body.

Cost of Entresto in the USA

At this time of writing, reports the cost for Entresto oral tablet (24 mg-26 mg) to be approximately $734 for a supply of 60 tablets.

Patients are encouraged to check with their local pharmacies, insurance providers, or explore patient assistance programs to determine the most cost-effective option for obtaining Entresto.

Why is Entresto so Expensive?

  • Research and Development: The development of new medications involves significant research and development costs, which are often reflected in the price of the final product.
  • Patent Protection: Entresto is protected by patents that grant exclusive rights to the manufacturer to produce and market the medication, limiting competition from generic alternatives.
  • Manufacturing Costs: The production of pharmaceuticals involves complex processes and quality control measures, which can contribute to the overall cost of the medication.
  • Marketing and Distribution: Pharmaceutical companies invest in marketing and distribution efforts to promote their products and make them available to healthcare providers and patients.

Entresto Alternatives

While Entresto is an effective treatment for heart failure with reduced ejection fraction (HFrEF), there are alternative medications available for patients who may not tolerate or respond adequately to Entresto. Some alternatives include:

  • Angiotensin-Converting Enzyme (ACE) Inhibitors: Medications such as lisinopril, enalapril, and ramipril are commonly used to treat heart failure by inhibiting the production of angiotensin II, a hormone that constricts blood vessels and increases blood pressure.
  • Angiotensin II Receptor Blockers (ARBs): ARBs such as losartan, valsartan, and candesartan work by blocking the effects of angiotensin II, leading to vasodilation and decreased blood pressure.
  • Beta-Blockers: Medications like carvedilol, metoprolol succinate, and bisoprolol are beta-blockers that help reduce the heart rate, blood pressure, and workload on the heart, improving symptoms and outcomes in heart failure patients.
  • Aldosterone Antagonists: Drugs such as spironolactone and eplerenone block the effects of aldosterone, a hormone that can worsen heart failure by promoting fluid retention and cardiac remodeling.
  • Hydralazine and Isosorbide Dinitrate: This combination is used as an alternative therapy in patients who cannot tolerate ACE inhibitors or ARBs.
  • Sacubitril/Valsartan (Entresto) Alternative Formulations: Some patients may benefit from alternative formulations of sacubitril/valsartan or other combination therapies tailored to their specific needs and tolerability.

FAQs of Entresto

What is Entresto used for?

Entresto is used to treat heart failure with reduced ejection fraction (HFrEF). It helps improve symptoms and reduce the risk of hospitalization and mortality in patients with this condition.

What are the worst side effects of Entresto?

The worst side effects of Entresto include symptomatic hypotension, hyperkalemia, renal impairment, angioedema, and fetal toxicity.

How long does it take for Entresto to work?

The onset of action of Entresto varies from person to person. Some patients may experience improvement in symptoms within a few weeks of starting treatment, while others may require longer to see significant benefits.

What happens if I stop taking Entresto?

Stopping Entresto abruptly can worsen heart failure symptoms and increase the risk of hospitalization and mortality.

What does Entresto do for the heart?

Entresto helps improve heart function by inhibiting neprilysin, an enzyme that breaks down beneficial vasodilatory and sodium excretion-promoting substances, and by blocking the effects of angiotensin II, a hormone that constricts blood vessels and increases blood pressure.

What happens if you double dose Entresto?

Taking a double dose of Entresto can increase the risk of side effects such as hypotension, hyperkalemia, and renal impairment.

Can I take pain relievers with Entresto?

Certain pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may interact with Entresto and increase the risk of renal impairment and hyperkalemia.

How long does Entresto stay in your system?

The elimination half-life of sacubitril and valsartan, the active ingredients in Entresto, is approximately 12 hours. It may take several days for Entresto to be completely cleared from the body after discontinuation.

How quickly does Entresto lower blood pressure?

Entresto can lower blood pressure within hours to days of starting treatment. However, the extent of blood pressure reduction may vary among individuals and depends on factors such as dosage, baseline blood pressure, and concomitant medications.

How long has Entresto been on the market?

According to the HSFA, Entresto was approved by the U.S. Food and Drug Administration (FDA) for the treatment of heart failure in July 2015 and has been available on the market since then.

Who makes Entresto?

Entresto is manufactured by Novartis Pharmaceuticals Corporation, a multinational pharmaceutical company headquartered in Switzerland.

What should I avoid while taking Entresto?

Patients taking Entresto should avoid potassium supplements, potassium-sparing diuretics, and high-potassium foods to reduce the risk of hyperkalemia.

What happens if you miss a dose of Entresto?

If a dose of Entresto is missed, patients should take it as soon as they remember, unless it is almost time for the next scheduled dose. Patients should not double the dose to make up for a missed dose and should resume their regular dosing schedule.

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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