Entresto is an oral prescription medicine that treats chronic heart failure in adults and children. It was approved by the FDA in 2015 for two main uses:

• Treat adults with chronic heart failure, especially those with reduced ejection fraction.

• Treat children aged one and older with heart failure and left ventricular systolic dysfunction. This is a type of heart failure where parts of the left side of the heart do not pump as forcefully as needed.

Entresto is the first drug in the angiotensin receptor and neprilysin inhibitor (ARNi) class approved by the FDA. It provides heart failure patients with a new treatment choice to discuss with their doctor. If Entresto seems like a good option for you or your child, talk to your doctor to determine if this medication is the right fit.

When filling an Entresto prescription, using a reputable online Canadian pharmacy like Canadian Med Center can save up to 90% on medication costs compared to U.S. pharmacies.

Entresto belongs to a new class of drugs called angiotensin receptor and neprilysin inhibitors (ARNis). It is currently the only ARNi available and combines two components to treat heart failure.

• The first component of Entresto is sacubitril, a neprilysin inhibitor. It works by preventing the breakdown of natriuretic peptides in the body, which are hormones that promote the removal of excess sodium and water through urination. Entresto helps reduce fluid buildup and decreases strain on the heart by stopping the breakdown of these peptides.

• The second component of Entresto is valsartan, an angiotensin II receptor blocker or ARB. It works by relaxing blood vessels so blood can flow freely throughout the body. By relaxing blood vessels, Entresto makes it easier for the heart to pump blood, which improves heart function.

Clinical studies have shown that Entresto effectively lowers the risk of heart failure hospitalization. Entresto also demonstrated improved survival benefits for heart failure patients compared to other standard treatment options.

When starting Entresto, your doctor will have you gradually increase the dosage over time until reaching the full maintenance dose. This gradual increase allows your body to adjust to the new medication and gives your doctor a chance to monitor for potential side effects like swelling beneath the skin (known as angioedema).

• For adults, the starting dose of Entresto depends on your medical history and other medications you may be taking. Over time, your doctor will have you increase the dosage with the goal of reaching the standard maintenance dose of 97 mg/103 mg taken twice daily.

• For children, the initial dosage and titration schedule is tailored to each child based on factors like their body weight, medical conditions, and any other medications they take. Compared to adults, the dosage increase is even more gradual to allow children ample time to adjust to Entresto.

Entresto is an oral tablet that should be taken twice daily—once in the morning and again at night.

Getting into a routine with the timing of your doses can help you remember to take your medication each day. For example, take your morning Entresto tablet as soon as you wake up. Then, take your evening tablet right before going to bed.

If you have difficulty swallowing tablets, talk to your doctor or pharmacist about getting Entresto as an oral suspension instead. This liquid form of the medication may be easier for you to swallow. 

What if I miss a dose of Entresto?

If you miss a dose of Entresto, take it as soon as you remember. However, if it is close to your next scheduled dose, simply skip the missed dose and continue with your regular dosing schedule. Do not take extra doses to make up for the missed one.

What happens if I take too much Entresto?

Data on Entresto overdoses is limited. However, a few clinical studies provide insight into what may happen if an excessive amount of Entresto is taken.

In one study, healthy volunteers took a single, high dose of Entresto that contained 583 mg of sacubitril and 617 mg of valsartan. Participants tolerated this large, one-time dose well.

Another study had volunteers take high daily doses of Entresto for two weeks. This involved taking 437 mg of sacubitril and 463 mg of valsartan every day for 14 days. Again, the participants tolerated the two weeks of high doses.

While these studies are reassuring, taking more Entresto than prescribed could potentially cause dangerous drops in blood pressure. Entresto works by relaxing blood vessels and lowering blood pressure. Excessive amounts could lead to severely low blood pressure, which requires emergency medical care.

Can I take Entresto during pregnancy?

When used during the second and third trimesters of pregnancy, Entresto may pose serious risks to your developing baby. Entresto acts on the renin-angiotensin system, which regulates blood pressure. Using Entresto or other drugs that affect this system later in pregnancy has been associated with harmful effects such as:

• Impaired kidney function in the fetus
• Fetal death
• Fetal injuries

While research on Entresto in early pregnancy is still limited, some studies have shown an increased risk of birth defects, miscarriage, and stillbirths.

If you are pregnant or hoping to conceive soon, discussing the risks of continuing Entresto with your doctor is very important. They may recommend switching you to an alternate medication that is safer during pregnancy.