Entresto (Sacubitril/Valsartan) for Heart Failure

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Entresto (sacubitril and valsartan) and Entresto Sprinkle are prescription medications approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of heart-related death and hospital stays in adults with chronic heart failure. They also treat certain children ages 1 and older with heart failure that affects the heart’s pumping ability.

What Members Say

MHT logo These insights are based on 1,350 comments about Entresto from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Ejection fraction often improves over time, sometimes substantially.
Breathing, stamina, and daily activities often feel easier after starting treatment.
Chest pain or angina sometimes eases, with less need for nitroglycerin.

Considerations:

Low blood pressure, dizziness, and lightheadedness are common concerns.
Kidney function and potassium levels often need regular blood test monitoring.
Side effects or low blood pressure may limit dose increases.

How Entresto Works and How It’s Taken

Entresto contains two medicines, sacubitril and valsartan, that work together to help the heart. Sacubitril increases natural substances that help regulate blood pressure and fluid levels. Valsartan blocks the effects of angiotensin 2, a hormone that can narrow blood vessels.

Doctors prescribe Entresto when:

Adults have chronic heart failure — Treatment can lower the risk of heart-related death and hospital stays due to heart failure. Benefits are clearest in people whose hearts pump out less blood than normal.
Children ages 1 and older have heart failure that affects the heart’s pumping ability — Treatment can help manage heart failure symptoms.

Entresto tablets: Entresto comes as tablets that can be taken with or without food. For people who cannot swallow tablets, a pharmacist can prepare Entresto as a liquid suspension. Shake the liquid well before measuring each dose.

Entresto Sprinkle: This form contains small pellets inside capsules. Open each capsule and sprinkle all the pellets onto one to two teaspoons of soft food, such as applesauce, yogurt, or pudding. Eat the food right away.

Do not swallow the capsules or chew or crush the pellets. Do not give the pellets through feeding tubes because they may cause a blockage.

Doctors may prescribe Entresto Sprinkle or the liquid form of Entresto for people who cannot swallow tablets. If someone switches between these forms, their doctor will adjust the dose as needed.

Typical Dosing for Heart Failure

The dose of Entresto or Entresto Sprinkle depends on age, body weight, kidney and liver health, and how well the medicine is tolerated. Both are taken twice daily.

Entresto Dosing for Adults

Starting dose — Usually 49/51 milligrams (sacubitril/valsartan) twice daily.
Target dose — 97/103 milligrams twice daily, usually after two to four weeks, if tolerated.
Lower starting dose — Half the usual starting dose is recommended for adults who are not taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin 2 receptor blocker (ARB), were previously taking low doses of these medicines, have severe kidney problems, or have moderate liver problems.

Entresto and Entresto Sprinkle Dosing for Children

For children ages 1 and older, doses depend on body weight and are usually adjusted every two weeks, if tolerated.

Less than 13 kilograms — Entresto liquid suspension is recommended.
13 to less than 40 kilograms — Entresto Sprinkle or the liquid suspension is recommended.
40 kilograms or more — Entresto tablets may be used, with doses based on body weight.

Children may need lower starting doses depending on their previous medicines, kidney health, or liver health.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Entresto

These insights are based on 1,350 comments about Entresto from MyHeartDiseaseTeam members and reflect individual experiences, not medical advice.

Members who use Entresto often recommend paying close attention to blood pressure, dizziness, fatigue, and other changes after starting or increasing the dose. They also highlight staying in touch with their cardiology team, keeping up with lab work, being patient about results, and asking about cost support.

1
Monitor your blood pressure, especially after dose changes.
“I monitor my blood pressure more often because taking Entresto with metoprolol made it drop too low, sometimes to 79/43. I also experienced dizziness, blurry vision, and weakness that made it hard to stand.”
2
Keep up with blood tests to check kidney function and potassium levels.
“My doctor called this a.m. to stop Entresto and spironolactone due to higher potassium and get some Rx to flush potassium out. Have to repeat blood work Monday.”
3
Ask about financial assistance if cost is a problem.
“I applied for and was granted a huge discount on my prescription. I only pay $10 a month.”

Connect with others who understand life with heart disease. Join MyHeartDiseaseTeam for free.

Entresto Side Effects

In a clinical study of adults taking Entresto, the most common side effects occurred in about 5 percent to 18 percent of people. These included:

Hypotension (low blood pressure)
Hyperkalemia (high potassium levels in the blood)
Cough
Dizziness
Kidney failure, including acute kidney failure

Serious Side Effects and Warnings

Entresto can cause serious side effects that may require immediate medical attention. It carries a boxed warning, the FDA’s strongest safety warning, for fetal toxicity. A boxed warning does not mean the drug is unsafe for everyone or that everyone faces the same level of risk.

Serious side effects and warnings include:

Fetal toxicity — Can harm or cause death to a developing baby during pregnancy.
Angioedema — A serious allergic reaction that can cause swelling of the face, lips, tongue, or throat and make breathing difficult.
Severe hypotension (low blood pressure) — Can cause dizziness, lightheadedness, or fainting.
Kidney problems — Worsening kidney function can be serious and may lead to kidney failure.
Severe hyperkalemia (high potassium levels in the blood) — This can be serious.

Get medical help right away if you think you are having a serious reaction.

How To Save on Entresto

Novartis, the manufacturer of Entresto, previously offered the Entresto Co-Pay Offer, but the program has been discontinued. Novartis continues to list an Entresto support contact for questions about treatment access.

For more information, visit Novartis Patient Support or call 888-368-7378.

What To Know Before Taking Entresto

Before starting Entresto or Entresto Sprinkle, your doctor will check your blood pressure, kidney function, and potassium levels to help determine if the medicine is right for you.

Tell your doctor if you are allergic to sacubitril, valsartan, or any other ingredients in these medicines or have a history of hereditary angioedema, a condition that causes episodes of swelling.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Be sure to mention:

Potassium supplements or salt substitutes containing potassium
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as certain pain relievers
Lithium

Also tell your doctor if you have kidney or liver problems or diabetes.

Do not take Entresto or Entresto Sprinkle if you:

Are allergic to any of their ingredients.
Have had angioedema caused by an ACE inhibitor or ARB.
Have hereditary angioedema.
Are taking an ACE inhibitor. You must wait at least 36 hours when switching between either form of Entresto and an ACE inhibitor.
Have diabetes and take a medicine containing aliskiren (Tekturna).

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your regular schedule.

Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. Entresto and Entresto Sprinkle can harm or cause death to a developing baby during pregnancy. Tell your doctor right away if you become pregnant during treatment.

Treatment should be stopped as soon as pregnancy is detected. Breastfeeding is not recommended while taking these medicines.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective are Entresto and Entresto Sprinkle for heart failure?

In a study of 8,442 adults with chronic heart failure, Entresto lowered the risk of heart-related death or hospital stays due to heart failure compared with enalapril (Vasotec), another heart medicine.

Heart-related death or hospital stays due to heart failure — Occurred in 21.8 percent of people taking Entresto versus 26.5 percent taking enalapril.
Death from any cause — Occurred in 17 percent of people taking Entresto versus 19.8 percent taking enalapril.

The benefits of Entresto are most clear in people whose hearts pump out less blood than normal.

In children ages 1 and older with certain types of heart failure, Entresto and Entresto Sprinkle are expected to improve heart-related outcomes. This is based on reductions in NT-proBNP, a blood marker used to track heart failure.

How long do Entresto and Entresto Sprinkle take to work for heart failure?

The study does not give an exact time frame for when people may start feeling better after taking Entresto or Entresto Sprinkle.

In the adult heart failure study, half of the people were followed for less than 27 months and half for longer. Treatment lasted up to 4.3 years. Doctors usually increase the dose after two to four weeks in adults and every two weeks in children, depending on how well the medicine is tolerated.

Do Entresto and Entresto Sprinkle interact with other medicines?

Yes. Entresto and Entresto Sprinkle can interact with certain medicines and increase the risk of side effects. These include:

ACE inhibitors — Must not be taken with Entresto or Entresto Sprinkle because of the increased risk of serious swelling (angioedema). People must wait at least 36 hours when switching between these medicines.
ARBs — Should be avoided because Entresto already contains valsartan, an ARB.
Aliskiren — Must not be taken with Entresto or Entresto Sprinkle by people with diabetes. It should also be avoided in people with certain kidney problems.
Potassium supplements and potassium-sparing water pills — May raise potassium levels in the blood. Salt substitutes containing potassium may have the same effect.
NSAIDs — Certain pain relievers may increase the risk of kidney problems, especially in older adults or people with existing kidney problems.
Lithium — May increase the risk of lithium toxicity, which can cause serious side effects.

Tell your doctor about all prescription medicines, over-the-counter drugs, vitamins, and supplements you take before starting Entresto or Entresto Sprinkle.