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Canadian Med Center

Entresto Administration and Dosages

Tuesday 9 April 2024
6 minute(s) read

Table of Contents

I. Interpreting Entresto Dosages

II. Entresto Dosages for Adults

i. Entresto Dosage Adjustments

III. Entresto Dosages for Children

IV. How To Take Entresto

i. Overdosing on Entresto

V. Conclusion

Living with heart failure can be challenging, and finding the right treatment can often feel like an uphill battle. Fortunately, new medications like Entresto offer more options for managing this chronic condition. However, using Entresto safely and effectively is essential to maximize its benefits.

In this article, we'll provide a comprehensive overview of interpreting Entresto dosages, common dosages for adults and children, and how to take the medication correctly. 

Interpreting Entresto Dosages

confused woman looking at Entresto tablet

The dosages listed on Entresto tablets can seem confusing at first glance. To make sense of them, it's helpful to understand what's in this medication.

Entresto contains two active ingredients that work together to treat heart failure: sacubitril and valsartan.

  • Sacubitril works by blocking neprilysin, an enzyme that breaks down certain peptides in the body. By blocking neprilysin, sacubitril allows these peptides to have greater effects, such as relaxing blood vessels and lowering blood pressure.
  • Valsartan blocks the binding of angiotensin II to receptors in the body. By doing so, it prevents angiotensin II from exerting its effects, such as constricting blood vessels and activating aldosterone. This, in turn, helps to prevent sodium retention and fluid buildup. [1]

Entresto dosages reflect the amount of each ingredient in milligrams. The dosages are listed with sacubitril first and valsartan second. For example, the 49/51 mg tablet contains 49 mg of sacubitril and 51 mg of valsartan. [2]

The three Entresto tablet strengths available are:

  • 24/26 mg tablet: 24 mg sacubitril/26 mg valsartan
  • 49/51 mg tablet: 49 mg sacubitril/51 mg valsartan
  • 97/103 mg tablet: 97 mg sacubitril/103 mg valsartan [2]

Knowing what each ingredient does and how the dosages are structured can take the confusion out of reading Entresto labels. Discuss any questions with your doctor or pharmacist to ensure you understand your prescribed Entresto dosage.

Entresto Dosages for Adults

When starting Entresto, your doctor will prescribe the medication at a low dose at first to ensure your body tolerates it well. Entresto therapy begins with a gradual dose increase over the first few weeks of treatment. [1]

  • To start, you will typically be given 49/51 milligrams of Entresto twice daily for two to four weeks. This lower initial dose allows your doctor to closely monitor you for any significant side effects as your body adjusts to the medication. The most serious potential side effect to watch out for is swelling beneath the skin, known as angioedema.
  • After this initiation period, if Entresto is well tolerated, your doctor will increase your dose to 97/103 milligrams twice daily. This standard dose is the level expected to provide you with the full benefits of Entresto. [1]

Entresto Dosage Adjustments

In some cases, your doctor may increase your dosage more slowly than the recommended pace. This decision is made based on your medical history and other medications you’re taking.

  • If you have liver dysfunction or kidney disease or have been prescribed low doses of ACE inhibitors or ARBs, your starting dose of Entresto may be lower. Typically, it would begin at 24/26 mg twice daily for a period of 2 to 4 weeks. Your doctor will then gradually increase the dosage every 2 to 4 weeks until you reach the desired maintenance dose.
  • If you are switching from an ACE inhibitor to Entresto, your doctor will advise you to discontinue the use of the ACE inhibitor and wait for a wash-out period of 36 hours before starting Entresto. This precautionary measure ensures that there are no potential interactions between the two medications. [1]

Entresto Dosages for Children

Entresto dosing in children is based on the child's body weight, with the goal of gradually increasing the dose every two weeks until reaching the standard maintenance dose. This gradual increase is called titration and allows the child's body to adjust to Entresto. [1]

  • For children under 40 kg, the starting dose is 1.6 mg per kg taken twice daily. After two weeks, the dose is increased to 2.3 mg per kg twice daily. The final maintenance dose is 3.1 mg per kg twice daily.
  • For children between 40 and 50 kg, the starting dose is 24/26 mg taken twice daily. After two weeks, this is increased to 49/51 mg twice daily. The final maintenance dose is 72/78 mg twice daily.
  • For children over 50 kg, the starting dose is 49/51 mg, taken twice daily. After two weeks, this is increased to 72/78 mg twice daily. The final maintenance dose is 97/103 mg twice daily. [1]

In some cases, the doctor may start with an even lower dose of Entresto for children. This includes children who:

  • Are not already taking full doses of ACE inhibitors or ARBs
  • Have kidney problems
  • Have liver impairment [1]

How To Take Entresto

Entresto is an oral medication that comes in tablet form. It's meant to be taken twice per day—once in the morning and again in the evening. [1]

Taking your Entresto tablets at the same times each day can help you remember your doses and stay on schedule. For example, take your morning tablet when you first wake up and your evening tablet right before bed. Getting into a routine like this makes it less likely you'll forget a dose.

If you do happen to miss a dose of Entresto, take it as soon as you remember. However, if it is nearly time for your next dose, take your next dose at the scheduled time and skip the missed dose. Do not double up or take extra doses to make up for a missed dose. [1]

If you have trouble swallowing tablets, talk to your doctor or pharmacist. They may be able to provide Entresto as an oral suspension instead. This is a liquid form of the medication that's easier to swallow. [1]

Overdosing on Entresto

tablets spilling out of medication bottle

There is limited data on Entresto overdoses. However, a few studies give us insight into what may occur if too much Entresto is taken. [1]

In one study, healthy volunteers took a single, high dose of Entresto containing 583 mg of sacubitril and 617 mg of valsartan. This large, one-time dose was well tolerated without any significant side effects. [1]

In another study, volunteers took high daily doses of Entresto for 2 weeks. This consisted of 437 mg of sacubitril and 463 mg of valsartan every day for 14 days. Again, the participants tolerated the two-week period of high doses without any major issues. [1]

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. Too much could lead to severely low blood pressure, which requires emergency care. [1]


Entresto provides heart failure patients with an innovative treatment option to help manage this chronic condition. However, close supervision and monitoring are required to ensure proper dosage and minimize adverse effects. With proper administration guided by doctors, Entresto can safely help relieve symptoms and reduce hospitalizations.

When taking any prescription medication, it’s important to stay informed about your treatment. Visit our Entresto blog to learn more about this medication.

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.