Side Effects of Entresto: Uses, Dosage, and Side Effects — A Clinical Overview

The side effects of Entresto most often include low blood pressure, high potassium levels, dizziness, cough, and changes in kidney function. Entresto is a prescription heart failure medicine, and regular clinical and blood-test monitoring helps clinicians use it as safely as possible.

Entresto at a glance: uses and how it works

Entresto is a prescription medicine that combines two active ingredients: sacubitril and valsartan. It is used to lower the risk of cardiovascular death and hospitalization for heart failure in adults with chronic heart failure. Its benefit is most clearly established in people whose left ventricular ejection fraction is below normal, although the prescribing clinician considers the full clinical picture when deciding whether it is appropriate.

In some countries, including under United States prescribing information, Entresto is also used in children aged 1 year and older with symptomatic heart failure caused by systemic left ventricular systolic dysfunction. Exact approved uses can vary by country, so patients should follow the information provided by their local clinician and pharmacist.

Sacubitril helps increase the activity of naturally occurring substances that can relax blood vessels and encourage the body to remove sodium. Valsartan blocks the effects of angiotensin II, a hormone that can narrow blood vessels and promote fluid retention. Together, these effects can reduce strain on the heart. Entresto is generally part of a wider heart failure care plan that may include other medicines, lifestyle measures, and follow-up for heart failure.

Side effects of Entresto: common and important effects

The side effects of Entresto are often related to its effects on blood pressure, kidney circulation, and potassium balance. In clinical trials and product labeling, commonly reported effects include low blood pressure, high potassium levels in the blood, cough, dizziness, and impaired kidney function. Not everyone experiences these effects, and their severity can range from mild and temporary to clinically significant.

Low blood pressure may cause light-headedness, tiredness, blurred vision, or feeling faint, especially when standing up quickly. It can be more likely in people who are dehydrated, take diuretics, have vomiting or diarrhea, follow a very low-salt diet, or use other medicines that lower blood pressure. A person who feels dizzy should sit or lie down promptly to reduce the risk of falling and should contact their healthcare team if the symptom is persistent, severe, or new.

High potassium usually does not cause clear symptoms, which is why blood testing is important. When potassium becomes significantly elevated, it can affect heart rhythm and may cause weakness, numbness, tingling, or palpitations. Changes in kidney function may also be detected on blood tests before a person notices symptoms; reduced urine output, unusual swelling, marked fatigue, or shortness of breath should be discussed promptly with a clinician.

• Commonly reported effects: low blood pressure, high potassium, cough, dizziness, and kidney-function changes.
• Less common but serious effect: angioedema, which is rapid swelling under the skin or lining of the mouth and throat.
• Monitoring helps identify blood pressure, potassium, and kidney changes early.

Angioedema and other serious reactions

Angioedema is an uncommon but potentially serious reaction associated with Entresto. It can cause swelling of the face, lips, tongue, throat, or around the eyes. Swelling involving the tongue or throat can interfere with breathing or swallowing and requires emergency medical care. Entresto should be stopped and evaluated urgently if angioedema is suspected; patients should not restart it unless a qualified clinician specifically advises it.

The risk of angioedema is particularly important for people who have previously had angioedema related to an ACE inhibitor or an angiotensin receptor blocker (ARB). Entresto is contraindicated for people with this history. It is also contraindicated in people with a known hypersensitivity to sacubitril, valsartan, or product ingredients.

Although a cough can occur with Entresto, it may also be related to heart failure, another respiratory condition, or another medicine. New or worsening cough, wheeze, breathlessness, or swelling should therefore not automatically be attributed to the medication. A clinician can assess whether symptoms relate to treatment, fluid buildup, infection, or another cause.

Who should not take Entresto and key precautions

Entresto must not be taken at the same time as an ACE inhibitor, such as lisinopril, enalapril, ramipril, or captopril. There must be at least a 36-hour interval between stopping an ACE inhibitor and starting Entresto. This separation is necessary because combining or closely sequencing these medicines raises the risk of angioedema.

It is also contraindicated with aliskiren in people who have diabetes. Because Entresto already contains valsartan, an ARB, it should generally not be combined with another ARB. People with severe liver problems, kidney disease, low blood pressure, dehydration, or a history of elevated potassium may need particular assessment and monitoring before and during treatment.

Entresto can harm a developing fetus when used during pregnancy. Anyone who is pregnant, planning pregnancy, or thinks they may be pregnant should contact the prescribing clinician promptly to discuss safer alternatives. Breastfeeding considerations may vary by local product information and individual circumstances, so these should also be reviewed with a healthcare professional.

Interactions and monitoring during treatment

Several medicines and supplements can affect the safety of Entresto. Potassium supplements, salt substitutes containing potassium, potassium-sparing diuretics, and other medicines that raise potassium can increase the chance of hyperkalemia. A clinician may recommend blood tests after starting treatment or making changes, particularly for people with kidney impairment or those using several heart or blood pressure medicines.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, may reduce kidney function in susceptible people and can lessen the blood-pressure-lowering effect of medicines such as Entresto. Lithium levels may rise when lithium is used with medicines affecting the renin-angiotensin system. Patients should tell their clinician and pharmacist about all prescription medicines, over-the-counter products, vitamins, herbal preparations, and electrolyte supplements.

Monitoring commonly includes blood pressure, kidney function, and potassium. The timing depends on a person’s health, other treatments, and recent results. Home blood pressure readings can be useful when requested by a clinician, but patients should not independently stop, restart, or change Entresto because of one reading unless they have been given a specific plan for doing so.

Dosage context and taking Entresto safely

Entresto is available in different strengths and formulations. The prescribed starting amount and any later adjustment depend on factors such as age, heart failure status, blood pressure, kidney and liver function, and prior use of related medicines. For this reason, the correct dose is individual and should be determined only by the treating clinician using the approved local prescribing information.

Patients should take Entresto exactly as directed and should check with a pharmacist if they are unsure about the formulation or instructions. If a dose is missed, the appropriate action depends on the product guidance and the individual treatment plan; taking extra medicine to make up for a missed dose is not appropriate unless a clinician has explicitly instructed otherwise.

Before procedures, hospital visits, or when seeing a new healthcare professional, patients should mention that they take Entresto. This is especially relevant if they develop vomiting, diarrhea, poor fluid intake, fever, or another illness that may cause dehydration. A healthcare professional may need to review medicines and blood pressure during acute illness.

When to seek medical care

Emergency medical care is needed for swelling of the lips, face, tongue, or throat; difficulty breathing or swallowing; fainting; or symptoms of a severe allergic reaction. These symptoms may indicate angioedema or a significant drop in blood pressure. Patients should not delay care while waiting to see whether symptoms improve.

Prompt medical advice is also appropriate for persistent dizziness, repeated near-fainting, unusually low blood pressure readings accompanied by symptoms, severe weakness, palpitations, reduced urination, or a sudden worsening of swelling or breathlessness. These symptoms can have several causes, including heart failure itself, but deserve timely assessment.

For non-urgent concerns such as a mild cough, occasional light-headedness, or questions about possible interactions, patients should contact their prescribing clinician or pharmacist. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals can assess heart failure medicines and related monitoring needs for international patients.

Frequently asked questions

What are the most common side effects of Entresto?

Commonly reported side effects include low blood pressure, high potassium levels, cough, dizziness, and changes in kidney function. Some of these effects may only be found through blood tests, which is why scheduled monitoring is important. A clinician can determine whether symptoms are likely related to Entresto or another health issue.

Can Entresto cause dizziness?

Yes. Dizziness can occur when Entresto lowers blood pressure, particularly after standing, during dehydration, or when it is taken with other blood-pressure-lowering medicines. Persistent, severe, or worsening dizziness should be reported to a healthcare professional, especially if it causes falls or near-fainting.

Why are potassium and kidney tests needed with Entresto?

Entresto can raise potassium levels and can affect kidney function, especially in people with existing kidney disease, dehydration, or certain medication combinations. Blood tests allow clinicians to identify these changes before they become serious. The clinician decides how often testing is needed based on the individual situation.

Can Entresto be taken with an ACE inhibitor?

No. Entresto must not be used at the same time as an ACE inhibitor because this increases the risk of angioedema, a potentially dangerous swelling reaction. At least 36 hours should pass after stopping an ACE inhibitor before Entresto is started, under clinician guidance.

Who should not take Entresto?

Entresto should not be used by people with a prior history of angioedema related to an ACE inhibitor or ARB, people taking an ACE inhibitor, or people with diabetes who are taking aliskiren. It is also not suitable for people with known hypersensitivity to its ingredients. Pregnancy requires urgent review with a clinician because the medicine can harm a developing fetus.

Should a person stop Entresto if side effects occur?

A person should not stop Entresto on their own for mild symptoms without first seeking medical advice, since it is prescribed to manage a serious heart condition. However, emergency symptoms such as facial or throat swelling, breathing difficulty, or fainting require immediate care. A clinician can advise whether the medicine should be paused, changed, or continued after evaluation.

References

• U.S. Food and Drug Administration
• European Medicines Agency
• National Heart, Lung, and Blood Institute
• American Heart Association
• MedlinePlus

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.