Entresto (sacubitril/valsartan) is a prescription oral tablet used for heart failure. Entresto does not come as a generic drug. Entresto may be prescribed for adults and children ages 1 year and older.

The active ingredients in Entresto are 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).

To learn more about Entresto, see this in-depth article.

Entresto has a boxed warning. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “What should I know before taking Entresto?” section.

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.

What are the symptoms of heart failure?

Symptoms of heart failure can include:

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

Who 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 also used in children with certain types of heart failure. See the “Is Entresto used in children?” section to learn more.

Entresto is prescribed to treat certain types of heart failure in people ages 1 year and older.

How does Entresto work?

Entresto contains the active ingredients sacubitril and valsartan. Both drugs help remove water and sodium from your body, which helps reduce your heart’s workload.

Valsartan also helps relax your blood vessels and lower your blood pressure. This also results in a reduced workload for your heart, which means your heart is better equipped to pump blood to your entire body.

Is Entresto used in children?

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.

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. This is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

Risk of fetal harm: 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 contraindications. These are factors or conditions that could keep your doctor from prescribing a drug due to risk of harm.

Entresto has the following contraindications:

  • 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

This section describes the usual dosages of Entresto.

What’s the usual dosage of Entresto?

Entresto comes in two forms and a variety of strengths, which are shown here in milligrams (mg).

Entresto oral tablets:

  • 24 mg sacubitril and 26 mg valsartan (also called 50 mg — the total of both strengths)
  • 49 mg sacubitril and 51 mg valsartan (also called 100 mg)
  • 97 mg sacubitril and 103 mg valsartan (also called 200 mg)

Entresto Sprinkle oral pellets within capsules:

  • 6 mg sacubitril and 6 mg valsartan (also called 12 mg)
  • 15 mg sacubitril and 16 mg valsartan (also called 31 mg)

In adults, the typical starting dose for Entresto is 49/51 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. (See the next section for details on how to administer the drug in these ways.)

For tips on making it easier to swallow tablets and capsules, check out this article.

To learn more about Entresto dosage in children, please see this article.

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.

How often should I take Entresto?

You should take Entresto as directed by your doctor.

Typically, Entresto is taken twice daily with or without food. Entresto’s prescribing information does not mention a best time of day to take the medication. But taking Entresto around the same time each day will help it work more effectively by keeping a steady level of the drug in your body.

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.

Taking Entresto for heart failure (its only approved use) may cause side effects in some people. These side effects can be mild to serious.

The lists below include some of the main side effects that have been reported with Entresto. For information about other possible side effects of this drug, talk with your doctor or pharmacist.

You can also learn more from this Entresto side effects article or from the drug’s prescribing information.

What are Entresto’s mild side effects?

Entresto may cause mild side effects in some people. These include dizziness and cough.

In many cases, mild side effects from this drug are temporary. And some side effects may be easy to manage. But if you have side effects that are ongoing or bothersome, talk with your doctor or pharmacist.

What are Entresto’s serious side effects?

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

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.

Allergic reaction

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.

In general, symptoms of allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should continue Entresto treatment.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Entresto, they may have you switch to a different treatment.

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.)

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.