Sacubitril/Valsartan: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Sacubitril/valsartan is a prescription medication primarily used to treat heart failure and related conditions. It works by helping the heart pump blood more effectively, which reduces the strain on the heart. This medication is often prescribed to improve heart function and lower the risk of hospitalization. Always consult your healthcare provider before starting or adjusting your dose. You can also reach out to one of our providers through telemedicine for further guidance.

Names of Medication

US Brand Name: Entresto (sacubitril/valsartan)

The “generic name” refers to the active ingredients in a medication, while the brand name is the name given by the manufacturer. In this case, sacubitril and valsartan are the generic names.

Pharmacologic Category

Angiotensin II Receptor Blocker (ARB)

Neprilysin Inhibitor

Sacubitril/Valsartan Dosage

Heart Failure: The typical starting dose is 49 mg/51 mg twice daily. After 2-4 weeks, your doctor may increase it to 97 mg/103 mg twice daily, depending on how well you respond to the treatment.

Hypertension: Although sacubitril/valsartan is primarily used for heart failure, it may also be prescribed for high blood pressure. The dosage is individualized based on your condition and response. Consult your doctor for specific dosing recommendations.

Chronic Kidney Disease: Sacubitril/valsartan may help protect kidney function in patients with heart failure. The usual dose is 49 mg/51 mg twice daily, but your doctor may adjust it based on your kidney function.

Heart Failure with Reduced Ejection Fraction (HFrEF): The recommended starting dose is 49 mg/51 mg twice daily, with a target dose of 97 mg/103 mg twice daily.

Heart Failure with Preserved Ejection Fraction (HFpEF): The dosage is similar to that for HFrEF, starting at 49 mg/51 mg twice daily, with adjustments as needed.

Left Ventricular Dysfunction: Sacubitril/valsartan may be prescribed to improve heart function after a heart attack. The starting dose is 49 mg/51 mg twice daily, with adjustments based on your condition.

Myocardial Infarction (Heart Attack): Your doctor may prescribe sacubitril/valsartan to support heart recovery after a heart attack. The typical dose is 49 mg/51 mg twice daily, adjusted as needed.

Coronary Artery Disease (CAD): Sacubitril/valsartan may help manage symptoms of CAD. The dose is individualized, typically starting at 49 mg/51 mg twice daily.

Atrial Fibrillation: Sacubitril/valsartan may be used in patients with both heart failure and atrial fibrillation. The starting dose is 49 mg/51 mg twice daily, with adjustments based on your response.

Pulmonary Hypertension: Although not a primary treatment, sacubitril/valsartan may be used in certain cases of pulmonary hypertension. The dose is individualized, so consult your doctor for specific recommendations.

Always consult your healthcare provider before adjusting your dose. If you have any questions or concerns, you can speak with one of our providers through telemedicine.

Dosage Forms and Strengths

24 mg/26 mg tablet

49 mg/51 mg tablet

97 mg/103 mg tablet

Administration Instructions for Sacubitril/Valsartan

Sacubitril/valsartan should be taken by mouth, usually twice daily, with or without food. Swallow the tablet whole with water. It is important to take this medication consistently at the same times each day. If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not double up on doses. Always follow your healthcare provider’s instructions carefully.

Sacubitril/Valsartan Side Effects and Adverse Reactions

Common Side Effects: Dizziness, fatigue, and low blood pressure (hypotension) are common side effects. These usually improve as your body adjusts to the medication.

Serious Side Effects: Swelling of the face, lips, or throat (angioedema), kidney problems, and high potassium levels (hyperkalemia) are more serious but less common. If you experience any of these, seek medical attention immediately.

Rare Side Effects: Allergic reactions, liver problems, and severe low blood pressure are rare but possible. Contact your doctor if you notice any unusual symptoms.

If you experience any side effects, consult your doctor or one of our telemedicine providers for advice on how to manage them.

Contraindications for Sacubitril/Valsartan

A contraindication is a specific situation where a medication should not be used because it may be harmful to the patient. For sacubitril/valsartan, there are several conditions and factors that make it unsafe to take. Below are the main contraindications:

History of angioedema: If you have ever had angioedema (swelling under the skin, often around the eyes and lips), especially when taking an ACE inhibitor or ARB, you should not take sacubitril/valsartan. This medication can increase the risk of angioedema, which can be life-threatening.

Use of an ACE inhibitor within 36 hours: Sacubitril/valsartan should not be taken if you have used an ACE inhibitor (like lisinopril or enalapril) in the past 36 hours. Combining these medications can increase the risk of severe side effects, including angioedema.

Severe liver disease: If you have severe liver impairment, sacubitril/valsartan may not be safe because your liver may not be able to process the medication properly, leading to increased side effects.

Pregnancy: Sacubitril/valsartan can cause harm to an unborn baby, especially in the second and third trimesters. It is contraindicated during pregnancy.

Allergy to sacubitril, valsartan, or any components of the medication: If you are allergic to any part of this medication, you should not take it, as it could cause a severe allergic reaction.

Drug to Drug Interactions with Sacubitril/Valsartan

Some medications can interact with sacubitril/valsartan, potentially increasing side effects or reducing its effectiveness. If you are taking any of the following, it’s important to discuss them with your healthcare provider:

ACE inhibitors (e.g., lisinopril, enalapril): Combining these with sacubitril/valsartan increases the risk of angioedema, a serious swelling reaction.

ARBs (e.g., losartan, candesartan): Since valsartan is an ARB, using it alongside other ARBs can lead to dangerously low blood pressure and kidney complications.

Aliskiren (brand name: Tekturna): Taking this blood pressure medication with sacubitril/valsartan may heighten the risk of kidney impairment, low blood pressure, and elevated potassium levels.

Potassium supplements or potassium-sparing diuretics (e.g., spironolactone, amiloride): These can raise potassium levels, which may become dangerous when combined with sacubitril/valsartan.

Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen): These medications may reduce the effectiveness of sacubitril/valsartan and increase the risk of kidney damage.

Lithium: Sacubitril/valsartan can elevate lithium levels in the blood, potentially leading to toxicity.

Sacubitril/Valsartan in Pregnancy

Is it safe to take sacubitril/valsartan during pregnancy? No, sacubitril/valsartan is not considered safe during pregnancy. It can cause serious harm to an unborn baby, particularly during the second and third trimesters. If you are pregnant or planning to become pregnant, inform your healthcare provider immediately. They will help you find a safer alternative to manage your condition.

Sacubitril/Valsartan While Breastfeeding

Is it safe to take sacubitril/valsartan while breastfeeding? The safety of sacubitril/valsartan during breastfeeding is not well established. It is unclear whether the medication passes into breast milk or could affect a nursing infant. If you are breastfeeding, it’s essential to discuss this with your healthcare provider to carefully weigh the risks and benefits. They may recommend an alternative treatment.

Estimated Cost of Sacubitril/Valsartan (Entresto)

The cost of sacubitril/valsartan can vary depending on your location and pharmacy. Without insurance, a 30-day supply of sacubitril/valsartan (brand name: Entresto) using a GoodRx coupon is estimated to range between $500 and $600. Prices may differ, so it’s a good idea to check with your pharmacy or use a discount service like GoodRx for the most accurate pricing.

Possible Alternatives to Sacubitril/Valsartan

If sacubitril/valsartan is not suitable for you, there are other treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these options with you.

Heart failure treatment: Alternatives include ACE inhibitors (e.g., lisinopril), ARBs (e.g., losartan), beta-blockers (e.g., metoprolol), and lifestyle changes such as reducing salt intake and increasing physical activity.

Hypertension: Other medications include calcium channel blockers (e.g., amlodipine), diuretics (e.g., hydrochlorothiazide), and lifestyle changes like weight loss, a low-sodium diet, and regular exercise.

Chronic kidney disease: ACE inhibitors and ARBs are commonly used, but lifestyle changes such as managing blood pressure, controlling blood sugar, and reducing protein intake can also help slow the progression of kidney disease.

Left ventricular dysfunction: Beta-blockers, ACE inhibitors, and ARBs are alternatives. Cardiac rehabilitation and lifestyle changes, such as quitting smoking and managing stress, can improve heart function.

Heart failure with reduced ejection fraction (HFrEF): ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists (e.g., spironolactone) are alternatives. Regular exercise and dietary changes are also beneficial.

Heart failure with preserved ejection fraction (HFpEF): Diuretics and beta-blockers may be used. Lifestyle changes, such as maintaining a healthy weight and managing blood pressure, are important.

Myocardial infarction (heart attack): ACE inhibitors, beta-blockers, and statins (e.g., atorvastatin) are common treatments. Lifestyle changes, including quitting smoking and adopting a heart-healthy diet, are critical for recovery.

Coronary artery disease: Statins, antiplatelet medications (e.g., aspirin), and beta-blockers are often used. Lifestyle changes, such as increasing physical activity and reducing cholesterol intake, are essential.

Atrial fibrillation: Blood thinners (e.g., warfarin), beta-blockers, and calcium channel blockers are alternatives. Lifestyle changes, such as reducing alcohol and caffeine intake, may help manage symptoms.

Pulmonary hypertension: Medications like endothelin receptor antagonists (e.g., bosentan) and phosphodiesterase-5 inhibitors (e.g., sildenafil) are alternatives. Regular physical activity and oxygen therapy may also be recommended.

Recent Updates on Sacubitril/Valsartan Research

Recent studies continue to explore the benefits of sacubitril/valsartan, particularly for patients with heart failure. A 2021 study published in the New England Journal of Medicine found that sacubitril/valsartan significantly reduced the risk of hospitalization and death in patients with heart failure with preserved ejection fraction (HFpEF), a condition with limited treatment options. Ongoing research is also investigating sacubitril/valsartan’s potential benefits for chronic kidney disease, as early data suggests it may slow the progression of kidney damage.

As more research emerges, sacubitril/valsartan may become a standard treatment for a broader range of cardiovascular and kidney conditions. Stay in touch with your healthcare provider or schedule a telemedicine visit with one of our providers to discuss how these updates may affect your treatment plan.

James Kingsley

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