What to Know Before Starting Entresto

If you are involved in the heart failure community, chances are, you have heard of Entresto - a novel drug that many have touted as a miracle. Entresto was approved in 2015 in both the United States and Canada. Overall, this makes it a relatively new drug, yet not new enough where there is limited data on its effectiveness in the real world.

What is Entresto?

Entresto is a combination pill containing sacubitril and valsartan. It is available in 3 different strengths. Sacubitril is not available by itself as a separate pill, whereas valsartan is. The two drugs work together to reduce the risk of hospitalization and death in people with moderate to severe heart failure. Specifically, the two therapies work to do this by:

• Sacubitril helps widen the blood vessels and facilitate removal of sodium through the urine. These two mechanisms of action reduce blood pressure.
• Valsartan is part of a group of blood-pressure lowering and kidney-protective agents called ARBs (Angiotensin II Receptor Blockers). Many people may already be on an ARB prior to starting Entresto. Studies have shown that Entresto is more effective than an ARB alone.

Drug interactions

If your doctor has prescribed Entresto, it is very important that he/she is aware of all the medications, vitamins, and herbal products that you are currently taking. If you are already taking an angiotensin-converting enzyme (ACE inhibitor), such as lisinopril or perindopril, among many others, it must be discontinued before starting Entresto. This is because ACE inhibitors work similarly to valsartan, one of the ingredients in Entresto. Taking the two together can cause dangerously high potassium levels, which can lead to death. To be on the safe side, it is recommended to allow a 36-hour washout period when switching from an ACE inhibitor to Entresto.¹

Side effects

All medications have side effects, but not everyone experiences them to the same degree. Common side effects of Entresto, which occurs in at least 10% of people who take the medication, include:¹

• Low blood pressure - this may occur during the beginning of therapy, but improve over time. If the low blood pressure is so severe that it results in fainting, it is important to receive prompt medical attention.
• Increase in blood potassium levels - this is more likely to occur in people who also have diabetes, renal dysfunction, and take potassium supplements and/or have a high potassium diet.

Less than 10% of people who take Entresto may experience:²

• Dizziness
• Falling
• Renal failure
• Feeling tired or weak
• Cough
• Angioedema - this refers to swelling of the skin and tissues around mucous membranes, such as in the face, tongue, throat, legs, and arms. People who experience this side effect are never restarted on an ARB again.

Who should not take Entresto?

There are some groups of people in which Entresto is not safe or not studied in. People who should not take Entresto include:

• Those with a prior reaction to an ACE inhibitor or an ARB
• Individuals taking an ACE inhibitor or an ARB
• Anyone with a history of angioedema
• Women who are pregnant or breastfeeding

Starting a new medication can be an overwhelming experience. Knowing what to expect during treatment helps reduce this anxiety and stress.