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Canadian Med Center

Entresto: Uses, Side Effects, and Interactions

Monday 8 April 2024
5 minute(s) read

Table of Contents

I. What is Entresto?

II. How Does Entresto Work?

III. Entresto Side Effects

IV. Entresto Drug Interactions

V. Entresto Usage During Pregnancy

VI. Conclusion

Entresto is a relatively new medication approved in 2015 for the treatment of chronic heart failure in adults and children. As the first FDA-approved medication in the angiotensin receptor and neprilysin inhibitor (ARNi) class, Entresto combines two complementary medicines in one pill to reduce the strain on the failing heart. [1]

In this article, we’ll discuss what Entresto is, how it works, side effects, drug interactions, and usage during pregnancy.

What is Entresto?

Heart failure is a serious condition that affects millions of people in the U.S. It occurs when the heart can't pump enough blood and oxygen to meet the body's needs. While heart failure can't be cured, treatments can help manage symptoms and improve quality of life. [2]

One medication that has made a big difference for some heart failure patients is Entresto. Entresto is an oral prescription medicine used to treat adults and children with long-lasting (chronic) heart failure. It helps reduce the risk of death and hospitalization. [1]

Entresto works by relaxing blood vessels so blood can flow more easily. This decreases the strain on the heart. Less strain means the heart doesn't have to work as hard to pump blood. [3]

Entresto was FDA-approved in 2015 to:

  • Treat adults with chronic heart failure. Improvements are seen the most in those with a reduced ejection fraction, which means the left side of the heart pumps out less blood than normal.
  • Treat children ages one year and older who have heart failure with systemic left ventricular systolic dysfunction. This is a type of heart failure where parts of the left side of the heart aren't pumping as strongly as they should. [1]

How Does Entresto Work?

illustration of the heart, kidneys, and circulatory system

Entresto belongs to a unique drug class called an angiotensin receptor and neprilysin inhibitor (ARNi). Entresto is the first and currently only drug in this new class. [1]

ARNis combine two medications - sacubitril and valsartan. Each component provides unique benefits that work together to improve heart health.

  • Sacubitril is a neprilysin inhibitor that prevents the breakdown of natriuretic peptides in the body. These peptides promote the removal of excess sodium and water through urination, reducing fluid buildup and decreasing the workload on the heart.
  • Valsartan is an angiotensin II receptor blocker (ARB). It relaxes blood vessels so blood can flow more freely. [3]

Clinical studies have shown that Entresto effectively lowers the risk of hospitalization for heart failure. It also demonstrates improved survival benefits for patients compared to other standard heart failure therapies. [1]

Entresto Side Effects

Side effects may occur with any medication, including Entresto. However, not all individuals experience side effects, and when present, their severity and nature can differ from person to person.

Some of the more common side effects of Entresto are usually mild. These include:

  • Cough
  • Low blood pressure
  • High potassium levels
  • Dizziness [1]

More serious side effects are possible with Entresto, although less likely. These include:

  • Angioedema: This is a severe, allergic reaction involving rapid swelling under the skin and around the throat, which can make breathing difficult. Angioedema is very rare but requires immediate medical care if it occurs.
  • Severely high potassium levels: In rare cases, Entresto can cause dangerously high potassium levels in the blood. This may lead to symptoms like confusion, weakness, irregular heartbeat, trouble breathing, or numbness in the extremities.
  • Kidney disease: Entresto has been linked to kidney disease in some instances. Signs may include decreased urine output, bloody or cloudy urine, and back or side pain. [1]

If you notice any symptoms related to these side effects, it’s crucial to contact your doctor immediately.

Entresto Drug Interactions

When taking a new medication, it's important to be aware of any potential interactions it may have with other drugs you are currently taking. This helps ensure your safety and prevent complications. Entresto is no exception. There are several key medication interactions to keep in mind if you are prescribed Entresto.

  • Aliskiren: Those with diabetes should avoid combining Entresto with Aliskiren. Aliskiren is used to treat high blood pressure, but when taken alongside Entresto by someone with diabetes, it can lead to risky health outcomes. Be sure to discuss any aliskiren use with your doctor before starting Entresto.
  • ACE inhibitors: Do not take ACE inhibitor medications with Entresto or within 36 hours of using Entresto. Doing so elevates the chance of angioedema, a severe swelling that can obstruct breathing.
  • Potassium-sparing diuretics, potassium supplements, or salt substitutes with potassium: Entresto increases the body's potassium levels, so combining them with these medications may cause dangerously high potassium levels.
  • NSAIDs: Entresto can worsen kidney function when used alongside NSAIDs by the elderly, individuals with compromised kidney function, or those on diuretics. This may lead to acute renal failure. Regular monitoring of kidney function is recommended if you fall into any of these categories. [1]

Entresto Usage During Pregnancy

pregnant woman taking medication

Entresto usage during the second and third trimesters of pregnancy can lead to harm and complications for a developing baby. The medication affects the renin-angiotensin system, which helps control blood pressure. Using Entresto or other drugs that act on this system in the later stages of pregnancy has been linked to: [1]

  • Reduced kidney function in the fetus
  • Fetal death
  • Fetal injuries [1]

While the effects of Entresto usage during the first trimester of human pregnancy have not been established yet, animal studies with Entresto showed increased embryo-fetal death in rats and rabbits, plus birth defects in rabbits. [1]

If you are pregnant or planning on becoming pregnant, it’s crucial to talk with your doctor about the risks of continuing Entresto. Your doctor may switch you to an alternative drug during your pregnancy. [1]


Entresto is an important new advancement in treating heart failure in adults and children. For many patients, Entresto can make a significant difference in managing this chronic condition.

However, as with any medication, educating yourself about Entresto is crucial to ensure safe and effective treatment. Visit our Entresto blog for more information about this new 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.