Key takeaways

  • Entresto can be used for heart failure in certain situations.
  • It works by helping remove water and sodium from your body and relaxing blood vessels to reduce your heart’s workload.
  • Studies show Entresto can reduce the risk of heart failure-related hospitalization and cardiovascular death more effectively than enalapril, an angiotensin converting enzyme (ACE) inhibitor.

Entresto is used to treat certain types of heart failure in adults and children ages 1 year and older.

Entresto has a boxed warning for the risk of fetal harm. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Heart failure is a condition in which your heart cannot pump enough blood to all parts of your body. As a result, these body parts won’t work as well since they rely on adequate blood flow for nutrients. If left untreated, heart failure can lead to serious complications, including death.

Symptoms of heart failure can include:

  • tiredness
  • nausea
  • difficulty breathing
  • cough
  • fluid buildup in your feet, ankles, and legs
  • weight gain

What stage of heart failure is Entresto prescribed for?

Entresto is primarily prescribed for adults with chronic (long-term) heart failure. It’s used to reduce the risk of cardiovascular death and hospitalization in people with heart failure. Entresto has been shown to be most effective in people with heart failure with reduced ejection fraction.

Entresto is used to treat systemic left ventricular systolic dysfunction heart failure in children ages 1 year and older with symptoms. This type of heart failure occurs when the left side of the heart is not working as well as it should.

Entresto contains the active ingredients sacubitril and valsartan. Sacubitril belongs to a group of drugs called neprilysin inhibitors. Valsartan belongs to a group of drugs called angiotensin II receptor blockers (ARBs).

Entresto helps reduce strain on the heart through two actions: sacubitril helps the body get rid of more sodium and fluid, and valsartan helps relax blood vessels and lower blood pressure.

Relaxed blood vessels also result in a reduced workload for your heart, which means your heart is better equipped to pump blood to your entire body.

Below is information regarding Entresto’s effectiveness in treating heart failure.

Heart failure in adults

A study compared the use of Entresto to the use of enalapril in adults with certain types of heart failure with symptoms. Enalapril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of heart failure with symptoms. People in this study took either Entresto or enalapril for up to 4.3 years.

To determine the drugs’ effectiveness, the study looked at how long it took for people to have a first occurrence of either heart failure-related hospitalization or heart-related death.

At the end of the study, Entresto was shown to be better than enalapril at reducing heart failure-related hospitalization and heart-related deaths. Entresto also helped improve overall survival rates in people with certain types of heart failure. This was based on a lower occurrence of heart-related deaths in people taking Entresto than in people taking enalapril.

Heart failure in children

A study was completed in children ages 1 month to less than 18 years with systemic left ventricular systolic dysfunction heart failure. This type of heart failure occurs when the left side of the heart is not working as well as it should. Children in this study took either Entresto or enalapril for their heart failure for 52 weeks.

The study looked at the reduction of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to determine each drug’s effectiveness in treating heart failure. NT-proBNP is a type of protein made by your heart and blood vessels. When your heart needs to work harder, it makes a larger amount of NT-proBNP. People with heart failure typically have higher NT-proBNP levels in their blood.

At 52 weeks, children taking Entresto showed an improvement in outcomes and a lessening of NT-proBNP levels. Children taking enalapril also had a reduction in NT-proBNP levels, but not as much as was seen in children taking Entresto.

Children taking Entresto or enalapril did have a larger reduction in NT-proBNP levels than adults taking Entresto in the above study. (And it’s unlikely this reduction was due to changes in other heart failure medications participants were taking.)

Because of the overall improvement in NT-proBNP levels in these studies, it’s reasonable to conclude that Entresto can help improve heart outcomes in children who have this type of heart failure.

Note: The effectiveness of Entresto in children ages 1 year and younger was not determined in this study.

Before you start Entresto, there’s some important information to keep in mind. This drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

Boxed warning

This drug has a boxed warning for the risk of fetal harm. This is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

Taking Entresto while pregnant may cause fetal harm. This is because the drug can cause the kidneys not to work as well in the unborn child. Because of this, doctors will not prescribe Entresto for a pregnant person unless it’s considered lifesaving and there are no other heart failure treatment options available.

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while taking this medication.

If you become pregnant while taking Entresto, talk with your doctor right away. They’ll likely recommend stopping Entresto and taking another medication if possible.

What other warnings should I know about?

In addition to a boxed warning, Entresto has other warnings. If any of the following medical conditions or other health factors apply to you, talk with your doctor before taking Entresto:

  • history of hereditary angioedema
  • kidney or liver problems
  • diabetes
  • pregnancy
  • breastfeeding
  • alcohol consumption

What are Entresto’s contraindications?

Entresto has the following contraindications (factors or conditions that could keep your doctor from prescribing a drug due to risk of harm):

  • history of angioedema related to taking an ACE inhibitor or an ARB
  • use of Entresto in combination with an ACE inhibitor
  • use of Entresto in combination with aliskiren (Tekturna) in people with diabetes
  • allergic reaction to Entresto or any of its ingredients

If you are switching from an ACE inhibitor to Entresto, you must wait at least 36 hours between the two medications.

In adults, the typical starting dose for Entresto is 49/51 milligrams (mg) twice daily. After 2 to 4 weeks, this dose may be increased to the maximum dose of 97/103 mg twice daily.

In children, the starting dosage of Entresto varies based on their weight. Typically, a child will begin with a starting dose and reach their maintenance dose after 4 weeks of Entresto treatment.

Children typically take Entresto twice daily. If a child cannot swallow tablets, Entresto can be given as pellets sprinkled over food or as an oral suspension.

Quick tip: To help make sure you don’t miss a dose, you can try using a medication reminder, such as downloading a reminder app on your phone.

How do you take Entresto?

Entresto comes as tablets you swallow. If you cannot swallow them, your pharmacist can help with crushing and mixing the tablets into a liquid you can drink. You should shake the liquid mixture well before use. This will ensure that you get a full dose of the drug.

Entresto also comes as pellets within capsules. To use this form of the drug, you’ll open the capsules and sprinkle the pellets on 1 to 2 teaspoonfuls of soft food. Eat the food right away. You should not swallow the capsules, and the pellets within the capsules should not be chewed or crushed.

Read more: Check out this article for suggestions on making it easier to swallow tablets and capsules.

The lists below include some of the main side effects reported with Entresto. For information about other possible side effects of this drug, talk with your doctor or pharmacist or check out the drug’s prescribing information.

Entresto may cause mild side effects in some people, including:

Sometimes, taking Entresto may lead to serious side effects. Examples include:

For some people, Entresto can cause an allergic reaction, but it’s not clear how often this side effect occurred in the drug’s studies.

Call your doctor right away if you have any serious side effects while taking Entresto. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Experiencing side effects? After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking this drug and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

The price of Entresto depends on several factors. These can include your treatment plan, your insurance coverage, the pharmacy you use, and your location.

Entresto is a brand-name drug that is not currently available as a generic.

To save money on your Entresto prescription, explore these Optum Perks coupons. (Note: Optum Perks coupons cannot be used with any insurance copays or benefits.)

Entresto can be used to treat heart failure in certain adults and children. If you have questions about whether Entresto is the best choice for you, talk with your doctor.

Disclaimer: While Healthline strives for factual, comprehensive, and current information, this article is not a substitute for a licensed healthcare professional’s expertise. Always consult a doctor before taking or discontinuing any medication. Drug information is subject to change and may not cover all uses, directions, precautions, warnings, interactions, reactions, or adverse effects. The lack of a warning does not guarantee a drug’s safety, effectiveness, or appropriateness for all patients or specific uses. Learn more about our approach to content integrity.