A Guide to Entresto: What It Is and How It Works

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In recent years, Entresto has emerged as a promising medication for managing heart failure. Its unique mechanism of action and effectiveness have made it a valuable tool in treating heart failure in adults and children.

In this guide, we'll explore what Entresto is, how it works, potential side effects, and interactions with other drugs.

What is Entresto?

Entresto is an oral prescription medication containing sacubitril and valsartan. The FDA approved Entresto in 2015 to treat heart failure in adults and children.

For adults, Entresto can help reduce the risk of cardiovascular death or hospitalization due to worsening heart failure. Its benefits are mostly seen in people with a reduced left ventricular ejection fraction, where the heart muscle is not pumping enough blood.

Entresto treats symptomatic heart failure in children ages one year and up. As with adults, it is used in pediatric patients who have heart failure with reduced ejection fraction. [1]

When taken consistently, Ernesto can lessen the burden of heart failure symptoms, keep people out of the hospital, and reduce mortality risk. [1]

How Entresto Works

Entresto is a combination of two medications: sacubitril and valsartan. Through complementary mechanisms, these drugs ease the workload of the failing heart in both adults and children. Together, they form an angiotensin receptor-neprilysin inhibitor (ARNI). [2]

Sacubitril plays a crucial role in blocking the breakdown of natriuretic peptides produced naturally in the body. These peptides cause sodium and water to pass into the urine, relieving strain on the heart. Additionally, they can reduce blood pressure and protect the heart from developing fibrosis, the formation of scar tissue that often occurs in heart failure.

Valsartan acts as an angiotensin-II-receptor antagonist. This means it blocks the action of a hormone called angiotensin II, which can harm patients with heart failure. By inhibiting the receptors that angiotensin II typically attaches to, valsartan prevents the hormone from exerting its detrimental effects on the heart. Furthermore, it helps reduce blood pressure by allowing blood vessels to widen. [2]

With a dual-acting mechanism, Entresto offers a valuable therapy for both adults and children with chronic heart failure involving reduced ejection fraction. By easing strain on the heart, it can enhance quality of life and potentially extend life expectancy. [2]

Entresto Side Effects

Entresto, like any medication, can cause side effects in some individuals. However, not everyone experiences adverse reactions, and the side effects tend to differ from person to person.

Common and usually less serious side effects of Entresto include cough and dizziness. These side effects are often mild and tend to go away on their own or with a minor adjustment in dosage or administration. However, you should immediately inform your doctor if these side effects become bothersome or persistent. [1]

More serious side effects are also possible with Entresto, though less likely to occur. These include:

High potassium levels: In rare cases, Entresto may cause high potassium levels in the blood. This can manifest as symptoms like confusion, weakness, an irregular heartbeat, trouble breathing, and numbness in the hands, feet, or lips. If you experience any of these symptoms, it is crucial to seek medical attention promptly.

Low blood pressure: Entresto may also lower blood pressure in some individuals. This can lead to symptoms such as light-headedness, dizziness, or fainting. If you experience any of these symptoms, it is advisable to inform your healthcare provider.

Kidney problems: Although rare, Entresto has been associated with kidney problems in some cases. Signs of kidney problems may include a decrease in urine output or frequency, bloody or cloudy urine, and lower back or side pain. If you notice any of these signs, it is important to consult your healthcare provider.

Allergic reactions: In rare instances, individuals may experience allergic reactions to Entresto. Symptoms of an allergic reaction may include itching or hives, swelling in the face or throat, chest tightness, and difficulty breathing. If you experience any of these symptoms, seek immediate medical attention. [1]

Entresto Drug Interactions

Entresto has the potential to interact with several other medications. It’s important to be aware of these interactions and talk to your doctor before starting or stopping any medications.

Aliskiren and Diabetes: If you have diabetes, it is crucial not to take Entresto in combination with aliskiren. This combination can lead to adverse effects.

Potassium-Sparing Diuretics, Potassium Supplements, and Salt Substitutes:
When taking Entresto, it is important to be cautious when using potassium-sparing diuretics (such as spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium. Combining these with Entresto may increase serum potassium levels. Discuss your medication regimen with your doctor to determine the best course of action to avoid any potential complications.

ACE Inhibitors: Avoid taking Entresto with ACE inhibitor medications or within 36 hours after using an ACE inhibitor. This combination can elevate the risk of angioedema, a severe swelling of the face, lips, tongue, or throat. As a precaution, inform your healthcare provider about any previous or current ACE inhibitor usage.

Lithium: If you are taking lithium, it is important to be aware that Entresto may increase lithium levels in your blood. This elevation can potentially lead to lithium toxicity. Your doctor may need to monitor your lithium levels more closely if you are prescribed Entresto. Always inform your healthcare provider if you are taking lithium or any other medications.

NSAIDs: For elderly patients, individuals with compromised renal function, or those on diuretic therapy, using NSAIDs (including COX-2 inhibitors) with Entresto may worsen renal function, possibly leading to acute renal failure. To minimize the risk, regular monitoring of renal function is recommended. If you are in any of these categories, consult your doctor before taking NSAIDs alongside Entresto. [1]

Conclusion

Entresto represents a significant advancement in treating heart failure with reduced ejection fraction, offering patients a new treatment option to choose from. Understanding the mechanisms of action, potential side effects, and drug interactions associated with Entresto is crucial for ensuring its safe and effective use.

To learn more about Ernesto, visit our dedicated Ernesto blog.

The content provided in this article is based on thorough research and in some cases, reviewed by a medical professional. Our goal for the information is to provide helpful, general health informational. It is not intended as a substitute for professional medical advice.

References

FDA Entresto (sacubitril and Valsartan) tablets, for oral use
Nicolas, D. Sacubitril-Valsartan