Entresto

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 22, 2022

Warnings

Entresto Risks, Warnings, and Complications

Entresto can cause serious health problems, especially in certain high-risk patients. Some of the risks of Entresto therapy include:

FETAL TOXICITY: Entresto (sacubitril/valsartan) can cause serious injury to the baby’s kidneys and even death of the unborn baby if taken by the mother during the last 6 months of pregnancy. Before starting Entresto, tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while on Entresto, stop taking the medicine and call your doctor immediately.
ANGIOEDEMA: Angioedema is a potentially life-threatening swelling of the face, throat, tongue, lips, or other parts of the body. It can cause dangerous breathing problems. The risk of angioedema is higher in Black people and those with a history of hereditary angioedema. People who have experienced angioedema with an ARB or ACE inhibitor medicine should not take Entresto (sacubitril/valsartan). If you experience symptoms of angioedema, stop taking Entresto and contact your healthcare provider without delay.
HIGH POTASSIUM: Taking Entresto can increase potassium levels in the body, which can lead to heart problems. The risk of this occurring is greater if you are on a high potassium diet or taking potassium supplements or other medications that have the same effect of raising serum potassium, such as potassium-sparing diuretics. The risk is also higher in people with kidney problems, diabetes, or a condition called hypoaldosteronism (low aldosterone). Avoid high-potassium foods, potassium supplements, and salt substitutes that contain potassium while on this medicine. Your doctor will monitor serum potassium periodically while you are on Entresto. Keep all lab appointments. Call your doctor immediately if you experience symptoms such as muscle weakness or irregular heartbeat.
LOW BLOOD PRESSURE: Entresto helps to lower blood pressure. It can occasionally cause a clinically significant decrease in diastolic and systolic blood pressure, causing you to feel lightheaded and dizzy. The risk of this occurring is higher if you take other medications for high blood pressure and diuretics (water pills). The symptoms usually go away after a few days of taking Entresto, but you should tell your doctor if they persist or if you notice low blood pressure readings at home. Follow your doctor’s instructions and drink the right amount of fluids.
WORSENING KIDNEY PROBLEMS: Entresto (sacubitril/valsartan) is generally good for the kidneys. However, it can sometimes lead to compromised renal function, especially if you have a history of kidney problems. In elderly patients, volume-depleted patients (including patients on diuretic therapy), or patients with severe renal impairment, the concomitant use of NSAIDs, including COX-2 inhibitors along with Entresto, can result in worsening of renal function and possible acute renal failure. These effects are typically reversible. Your doctor will order blood tests to check your kidney function before starting you on Entresto. They will also monitor renal function periodically while you are taking this medication. Your doctor will closely monitor serum creatinine if you have impaired renal function. Keep all lab and doctor’s appointments. Call your doctor if you notice that you’re urinating less than usual or your urine is dark-colored.

If you are at a high risk of complications from Entresto use, your doctor or pharmacist can adjust the dose or offer alternative treatments.

Precautions Before Starting Entresto

Tell your healthcare provider if you have ever had an allergic reaction to Entresto (sacubitril/valsartan), any of the active or inactive ingredients in Entresto tablets, other angiotensin receptor blockers, or an ACE inhibitor medicine. Your pharmacy can give you a list of ingredients in Entresto.

If you have diabetes, tell your doctor if you are taking a medication called aliskiren (Tekturna, Tekturna HCT). Your doctor will likely tell you not to take Entresto.

Tell your healthcare provider if you are on an ACE inhibitor or have taken an ACE inhibitor within the past 36 hours. Examples of ACE inhibitors include lisinopril (in Prinzide, in Zestoretic), benazepril (Lotensin, in Lotrel), enalapril (Vasotec, in Vaseretic), perindopril (Aceon, in Prestalia), moexipril (Univasc, in Uniretic), quinapril (Accupril, in Accuretic, in Quinaretic), trandolapril (Mavik, in Tarka), ramipril (Altace), captopril, and fosinopril. Your doctor will likely tell you not to take Entresto if you are on an ACE inhibitor.

Give your healthcare provider a complete medical history. Entresto may not be right for people with certain medical conditions such as kidney or liver problems, diabetes, and hereditary angioedema.

Give your doctor a complete list of all your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. This can help avoid serious drug interactions between Entresto and your other medications.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Entresto

Keep all your medical and lab appointments while on Entresto. Your doctor may want to check how well the medication is working to control your heart failure. They may order certain laboratory tests to monitor your kidney function and potassium levels during treatment with this medication.

Entresto can cause lightheadedness, dizziness, and fainting. These symptoms are more likely to occur if you go too quickly from a sitting or lying position to standing, especially when you first start taking Entresto. Tell your doctor if this occurs. To prevent this problem, get up slowly from a lying position and keep your feet on the ground for a few minutes before standing up.

Diarrhea, vomiting, sweating, and dehydration can cause a drop in blood pressure, leading to lightheadedness and fainting. Tell your healthcare provider if you experience these symptoms during Entresto treatment.

Do not use potassium supplements or salt substitutes that contain potassium while on Entresto without talking to your doctor. If advised, follow your doctor’s instructions carefully about fluid intake and a low-sodium (low-salt) diet.

Call your doctor if you become pregnant while on Entresto. Do not breastfeed while on this medicine.

Entresto Drug Interactions

Taking Entresto with some other medications can affect how the medications work. Drug interactions between medications can also increase the risk of serious adverse reactions. Your physician may choose different medications for you, change the dose or frequency of one or both medicines, and/or closely monitor you for side effects if there are known interactions between Entresto and your other medications.

There can be potential interactions between Entresto and the following medications:

Angiotensin receptor blockers (ARBs) such as losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, in Benicar HCT, in Tribenzor), candesartan (Atacand, in Atacand HCT), irbesartan (Avapro, in Avalide), azilsartan (Edarbi, in Edarbyclor), eprosartan (Teveten), telmisartan (Micardis, in Micardis HCT, in Twynsta).
Diuretics or water pills, including potassium-sparing diuretics such as spironolactone (Aldactone, in Aldactazide), amiloride (Midamor), and triamterene (Dyrenium, in Dyazide, in Maxzide)
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin) as well as selective COX-2 inhibitors like celecoxib (Celebrex)
Cholesterol-lowering medications like gemfibrozil (Lopid)
Other medications used to treat high blood pressure and heart problems
Potassium supplements
Lithium (Lithobid)

This list does not describe all possible Entresto drug interactions. Give your healthcare professionals a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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