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Entresto®

Also called sacubitril and valsartan

Key points about Entresto®

Entresto is used to treat heart failure (weak heart pump).
Entresto is also called sacubitril and valsartan.
It belongs to a class of medicine called angiotensin receptor neprilysin inhibitors (ARNIs).
Find out how to take Entresto safely and possible side effects.

Son helping father take medicine with water

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Entresto is used to treat some types of heart failure. Heart failure occurs when your heart is weak and can't pump enough blood to your lungs and the rest of your body. The most common symptoms of heart failure are breathlessness, fatigue, tiredness and ankle swelling. Entresto relaxes your blood vessels and reduces excess fluid in your body, which makes it easier for your heart to pump blood around your body. Read more about heart failure.

Entresto is made up of 2 medicines (sacubitril and valsartan) combined into 1 tablet.

If you're currently taking an ACEI (captopril, enalapril, lisinopril, perindopril, quinapril, ramipril):

You'll need to stop taking it at least 36 hours before you start Entresto.
Your healthcare provider will tell you when and how to do this.

If you're currently taking an ARB (candesartan, losartan and irbesartan):

You'll need to stop taking it.
Start Entresto the following day after stopping the ARB.

ACEI = Angiotensin Converting Enzyme Inhibitor

ARB = Angiotensin Receptor Blocker

Entresto is made up of 2 medicines (sacubitril and valsartan) as a combination in each tablet.

In Aotearoa New Zealand, there are 3 strengths of Entresto tablets. Check with your pharmacist which strength you are taking.

The dose of Entresto is usually 1 tablet twice daily.
Your doctor will decide your starting dose based on which medicines you have been taking before.
The dose may be adjusted depending on your response to treatment.
Always take your Entresto exactly as your doctor has told you.
The pharmacy label on your medicine will tell you how much Entresto to take, how often to take it and any special instructions.

Timing: Take your Entresto tablets 2 times a day – 1 tablet in the morning and 1 tablet in the evening. You can take Entresto with or without food. Take your tablets about the same time each day.
Swallow your tablet with a glass of water: If you have trouble swallowing the tablets, they can be crushed and mixed with a small amount of water, yoghurt or apple puree. Talk to your pharmacist for guidance.
Missed dose: If you forget to take your dose of Entresto, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.
Keep taking Entresto regularly: Stopping your treatment with Entresto may cause your heart failure symptoms to get worse. Don't stop taking your Entresto unless your doctor tells you to.

Entresto is not suitable if you're pregnant or planning a pregnancy.
It's also not suitable if you have had a severe allergic reaction to an ACE inhibitor in the past, eg, swelling of your lips, eyes or tongue (called angioedema).

Monitoring

Your doctor will arrange for you to have blood tests and blood pressure checks before you start taking Entresto and during your treatment, especially when you first start taking it. This is to check how it is working and to check your kidneys and potassium levels.

Have a sick day plan

If you have diarrhoea (runny poo) or are vomiting (being sick) from a stomach bug, or are dehydrated from another illness, it’s important to let your healthcare provider know, as they may advise you to stop taking your Entresto for a few days, or decrease the dose and start again when you feel better.

Be careful when taking some pain relief medicines

Entresto may interact with other medicines and herbal supplements, so check with your doctor or pharmacist before starting Entresto and before starting any new medicines.

Don't take NSAIDs (anti-inflammatory pain relief medication) unless you have spoken to your prescriber or pharmacist.

The combination of Entresto with NSAIDs can worsen your heart failure and is harmful to your kidneys. Examples of commonly used NSAIDs are:

ibuprofen (eg, Nurofen)
diclofenac (eg, Voltaren)
naproxen
celecoxib.

Some of these medicines can be found in cough and cold preparations. Read more about NSAIDs.

Like all medicines, Entresto can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Nausea (feeling sick) Vomiting (being sick) Headache Diarrhoea (runny poo) Stomach pain	These are quite common when you first start taking Entresto and usually get better with time. Tell your doctor if you've have been vomiting or if you are bothered by these side effects.
Dizziness, feeling faint or lightheaded	Dizziness is quite common when you first start taking Entresto. Be careful as you are at increased risk of falls, especially when you stand up from sitting or lying down. Get up slowly out of bed or stand up slowly. Take a few minutes to sit on your bed or on a chair first. The dizziness goes away after a while. If the dizziness is severe or ongoing, tell your doctor.
Cough Tiredness	Tell your doctor if these bother you.
Signs of an allergic reaction such as skin rash, itching, swelling of your lips, face, and mouth, or difficulty breathing	Tell your doctor immediately or phone Healthline 0800 611 116.
Read more about medicines and side effects and reporting a reaction you think might be a side effect.