Sacubitril / Valsartan

Entresto Tablets

Entresto, a combination of sacubitril and valsartan, is approved by the FDA to treat heart failure in adults and symptomatic children over one year old. It works by enhancing heart function and reducing hospitalizations related to heart failure. The medication is taken in tablet form, with doses adjusted based on individual health conditions. Entresto interacts with several medications, including ACE inhibitors, ARBs, certain diuretics, and lithium, potentially requiring dosage adjustments. It’s essential for patients to discuss all medications and supplements with their healthcare providers to avoid adverse interactions and to ensure safe and effective treatment. So, if you want to buy Entresto tablets to treat chronic heart failure, you need to get a prescription from your doctor.

Product Overview

Entresto, containing sacubitril and valsartan, is primarily prescribed for treating chronic heart failure in adults and symptomatic children aged one year and older. The medication enhances heart efficiency and lowers the risk of cardiovascular death and hospitalizations. It is administered orally in tablet form, available in various strengths, and may be converted into an oral suspension for those who have difficulty swallowing.

The dosage of Entresto is tailored to individual needs, starting lower and potentially increasing based on the patient’s response and tolerance. Regular medical supervision is necessary to adjust dosages and monitor heart function. Key interactions of Entresto include those with ACE inhibitors, which should not be taken within 36 hours of Entresto due to the risk of severe allergic reactions like angioedema. Similarly, when combined with ARBs or certain diuretics, such as potassium-sparing diuretics, the risks of increased blood potassium levels and other side effects heighten, necessitating careful medical oversight.

Furthermore, combining Entresto with lithium could raise lithium to dangerous levels, requiring adjustments in lithium dosage. While no specific food interactions are noted, it’s crucial for patients to discuss the use of any herbs or supplements with healthcare providers to prevent potential negative interactions. Entresto’s efficacy and safety profile make it a significant option for managing heart failure. However, its use requires careful consideration of possible drug interactions and close monitoring by healthcare professionals to optimize treatment outcomes and minimize risks.

Uses of Entresto

Entresto, a combination of sacubitril and valsartan, is approved for use in the following groups:

• Adults with Chronic Heart Failure: It is used to reduce the risk of cardiovascular death and hospitalization due to heart failure.
• Children Ages 1 Year and Older: It is indicated for children who have symptomatic heart failure accompanied by systemic left ventricular systolic dysfunction.

How to Use Entresto?

Dosage

Entresto is a prescription medication available as a tablet in three dosage strengths:

• 50 mg Tablet: Contains 24 mg of sacubitril and 26 mg of valsartan, totaling 50 mg.
• 100 mg Tablet: Contains 49 mg of sacubitril and 51 mg of valsartan, totaling 100 mg.
• 200 mg Tablet: Contains 97 mg of sacubitril and 103 mg of valsartan, totaling 200 mg.

Recommended Dosage for Different Patients

Dosage for Heart Failure

• Starting Dosage: Initially, you will be prescribed Entresto at a dosage of 49/51 mg, to be taken twice daily.
• Adjustment Period: After 2 to 4 weeks, based on your response to the medication, your doctor may increase the dosage to 97/103 mg, also to be taken twice daily.

This approach allows your doctor to carefully monitor your response to the medication and adjust the dosage to an effective level for managing your heart failure.

Dosage for Children

• General Administration: Children aged 1 year and older typically take Entresto twice daily, similar to adults.
• Dosage Form for Young Children: For children who weigh less than 88 pounds (approximately 40 kilograms), Entresto is recommended as an oral suspension. This form allows accurate dosing using an oral syringe.
• Dosage Adjustments Based on Age and Weight: The dosage of Entresto for children is tailored based on their specific weight and age. The doctor will gradually increase the dose every 2 weeks until the optimal dosage is established for ongoing treatment.

Dosage for Children Under 88 lbs (40 kg)

• Starting Dose: The initial dosage is 1.6 mg/kg, administered twice daily.
• Adjustments: After 2 weeks, the dose may be increased to 2.3 mg/kg. Following another 2 weeks, it may be further increased to 3.1 mg/kg.
• Preparation: A pharmacist will prepare the oral suspension and provide instructions on the correct amount for your child to take.

Dosage for Children Weighing 88 lbs to 110 lbs (40 kg to 50 kg)

• Starting Dose: The usual starting dose is 24/26 mg, taken twice daily.
• Adjustments: After 2 weeks, the dose may be increased to 49/51 mg. After 4 weeks, the dose may be increased further to 72/78 mg.
• Dosing Method: The 72/78 mg dose can be achieved by taking three 24/26 mg tablets.

Dosage for Children Weighing Over 110 lbs (50 kg)

• Starting Dose: The usual starting dose is 49/51 mg, taken twice daily.
• Adjustments: After 2 weeks, the dose may be increased to 72/78 mg. After another 2 weeks, it may be increased to 97/103 mg.

These dosage adjustments are based on the child’s response to the medication under the guidance of their doctor. Always follow the specific instructions provided by your child’s healthcare provider.

Long-Term Use

Entresto is intended for long-term treatment. If both you and your doctor find that Entresto is safe and effective for your condition, you will likely be prescribed this medication for ongoing use. This approach helps ensure sustained management of your symptoms and overall health improvement under medical supervision.

[Note: Entresto’s recommendations can vary from person to person. You can discuss them with your doctor or healthcare giver, and they’ll customize your Entresto tablet dosage accordingly.]

How to Take It?

• The specific dosage of Entresto that your doctor prescribes will be based on several important factors:
  • Condition Treated: The type and severity of the condition for which you are being treated.
  • Personal Characteristics: Your age and weight.
  • Medication Form: The particular form of Entresto you are prescribed.
  • Other Health Issues: Any other medical conditions you may have.
• Always take Entresto as directed by your doctor or another healthcare professional.
• Entresto is available in tablet form.
• If you cannot swallow tablets, ask your pharmacist to prepare an oral suspension by crushing the tablets and mixing them with a liquid. Use an oral syringe to take this form.
• Take Entresto twice daily, ideally at the same times each day, spaced about 12 hours apart.
• Set reminders on your phone or use a medication timer to help you remember each dose.
• Your doctor might adjust your dosage based on your response to the medication and any side effects you experience.
• Entresto can be taken with or without food.
• Do not split or chew the tablets unless advised by a healthcare professional.
• Regularly consult with your doctor to ensure the method and dosage of taking Entresto are optimal for your condition.
• Initially, your doctor will likely start you on a lower dosage of Entresto. They will then adjust this dosage gradually to find the level that is most effective for you. The goal is to use the smallest dosage that still achieves the desired therapeutic effect.
• The dosages mentioned here are typically used and recommended, but you should always follow the specific dosage prescribed by your doctor. Your doctor will determine the best dosage tailored to your individual needs.
• Entresto tablets are designed to be taken orally by swallowing. However, if you have difficulty swallowing tablets, there is an alternative method available:
  • Oral Suspension: If you cannot swallow the tablets, your pharmacist can crush the Entresto tablets and mix them with a liquid to create an oral suspension. This mixture allows you to drink the medication instead.
• The pharmacist typically uses the 49/51 mg strength of Entresto tablets to prepare the suspension. The resulting mixture will have a concentration of 4 mg per 1 mL, with a total volume of 800 mg in 200 mL of liquid. This format ensures that you receive the medication in a form that is easier to ingest if swallowing tablets is challenging.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Entresto Work?

Entresto combines two active ingredients to support heart function: sacubitril and valsartan. Sacubitril is part of the neprilysin inhibitor class, which targets the enzyme neprilysin, known for breaking down beneficial peptides that help your body eliminate sodium and fluid. By inhibiting neprilysin, sacubitril increases these peptides, enhancing fluid and sodium removal and easing the workload on the heart. Valsartan belongs to the class of drugs known as angiotensin II receptor blockers (ARBs). It operates by blocking the effects of the hormone angiotensin II, leading to relaxed blood vessels and improved elimination of water and salt by the kidneys. This action results in lowered blood pressure and reduced stress on the heart. Together, sacubitril and valsartan work synergistically to help the heart pump blood more efficiently throughout the body.

Important Safety Information

Side Effects

Common side effects of Entresto may include:

• Dizziness 
• Cough 

Serious side effects of Entresto may include:

• Hyperkalemia (high level of potassium in the blood). Signs may include:
  • Muscle weakness
  • Heart rhythm problems
  • Nausea
  • Slow heart rate
  • Trouble breathing
• Kidney problems, like kidney failure. Signs may include:
  • Dark-colored urine
  • Confusion
  • Itchy skin
  • Swelling in the feet and legs
  • Producing a small amount of urine

• Fetal toxicity (fetal harm)
• Severe allergic reaction
• Hypotension (low blood pressure)

[Note: This list may not cover all possible side effects of Entresto tablets. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

Before starting Entresto, it’s important to discuss your medical history with your doctor. Entresto may not be suitable for you if you have certain health conditions. These include:

• Angioedema: If you have experienced angioedema with angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors previously, you are at increased risk of it recurring with Entresto. Angioedema is a serious allergic reaction that can be life-threatening. Discuss with your doctor alternative treatments for heart failure that might be safer for you.
• Allergic Reaction: If you have previously experienced an allergic reaction to Entresto or any of its ingredients, it is crucial that you avoid this medication. Allergic reactions can range from mild to severe and pose significant health risks. It’s important to consult with your doctor to discuss alternative treatments for heart failure that are safer for your specific health profile. Your doctor can recommend different medications or therapies that effectively manage your condition without the risk of an allergic response.
• Diabetes and Aliskiren: If you have diabetes and are taking the medication aliskiren (Tekturna), you should avoid using Entresto. Combining Entresto with aliskiren increases the risk of serious kidney issues, including kidney failure. It can also lead to hyperkalemia (an elevated potassium level in your blood) and hypotension (low blood pressure). These conditions can have severe health implications, so it’s crucial to discuss alternative medications with your doctor that might be safer and more effective for managing your condition.
• Severe Liver Disease: Entresto is generally not recommended for individuals with severe liver disease due to the potential for exacerbated health problems. The drug’s effects on a compromised liver can lead to worsening of the liver condition or additional complications. If you have liver disease, it is essential to consult with your doctor to evaluate whether Entresto is a suitable option for your heart failure treatment or if other therapies might pose less risk and provide better management of your condition.
• Changes in Weight: Weight gain was not observed in clinical studies of Entresto, but it is common to experience rapid weight changes when you have heart failure. An increase in weight could indicate that your heart failure is worsening, possibly because your heart is not pumping effectively and fluid is accumulating in your body. It’s important to monitor your weight daily and discuss these measurements with your doctor during each visit. If you notice sudden weight changes or if you’re concerned about your weight, consult your doctor. They can determine if your heart failure is the cause and recommend appropriate treatments.

Boxed Warning 

FDA Warning About Risk of Fetal Harm: You should not take Entresto if you are pregnant. This medication can harm the fetus and carries a serious warning, known as a boxed warning, from the Food and Drug Administration (FDA). This type of warning is used to highlight potentially dangerous effects of a medication. Using Entresto during pregnancy can cause serious kidney problems in the child, which can be fatal. If you find out you are pregnant while taking Entresto, stop using the medication immediately and consult your doctor. Your doctor might suggest a different medication for treating your heart condition. They may also conduct ultrasound exams to monitor your and your baby’s health. If you took Entresto during pregnancy, it’s important to watch your newborn for certain conditions, which include:

• Hypotension (low blood pressure)
• Hyperkalemia (high potassium levels in the blood)
• Oliguria (producing very little urine)

Precautions

• Birth Control: It is unsafe to take Entresto during pregnancy. If you are sexually active and there is a possibility of pregnancy for you or your partner, discuss your birth control options with your doctor while using Entresto.

• Breastfeeding: It is advised not to breastfeed while taking Entresto. It is currently unknown whether Entresto passes into human breast milk or how it might affect a breastfed child. Although Entresto has been shown to pass into the milk in animal studies, these findings may not necessarily apply to humans. If you plan to breastfeed, consult your doctor before starting Entresto. They can help you explore the safest ways to nourish your baby and discuss suitable treatments for your heart condition.

Contraindications

Entresto should not be used in patients who:

• Have a history of hypersensitivity to sacubitril, valsartan, or any other components of the product.
• Have experienced angioedema related to previous therapy with ACE inhibitors or ARBs.
• Are currently taking ACE inhibitors. There should be a gap of at least 36 hours between stopping the ACE inhibitor and starting Entresto.
• Have diabetes and are taking aliskiren, a renin inhibitor.

Missed Dose

• If you forget to take a dose of Entresto, take it as soon as you remember.
• If it’s almost time for your next dose, skip the missed dose and continue with your regular dosing schedule.
• Do not take more than one dose at a time to avoid an increased risk of side effects.
• If you are concerned about any missed doses, talk to your doctor for advice.
• To help ensure you don’t miss a dose, consider setting a reminder on your phone or using a medication timer.

[Note: If you have missed a medication dose of Entresto tablets and are unsure when to take the next one, immediately consult your doctor or pharmacist.]

Overdose 

Taking more Entresto than your doctor recommends can result in severe side effects, including hypotension (low blood pressure), which is a common symptom of an overdose. If you suspect that you have taken an excessive amount of this medication, immediate action is necessary:

Contact your doctor as soon as possible for advice. Call America’s Poison Centers or use their online tool for guidance. Seek emergency help if your symptoms are severe. Call 911 or visit the nearest emergency room immediately. Prompt response is crucial to managing the effects of an overdose effectively.

[Note: If you consumed more than the recommended Entresto dose, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

Storage

• Store Entresto tablets at room temperature, between 68°F to 77°F (20°C to 25°C).
• Keep tablets in a tightly sealed container to protect them from light.
• Avoid storing the medication in damp or wet areas, such as bathrooms, to prevent damage.
• If you are using Entresto as an oral suspension, store it at room temperature, between 68°F to 77°F (20°C to 25°C), for up to 15 days.
• The oral suspension should not be refrigerated. It is prepared by a pharmacist who crushes Entresto tablets and mixes them with a liquid.
• Safely dispose of any unused Entresto to prevent accidental ingestion by children, pets, and others.
• Proper disposal also prevents environmental damage. Follow local guidelines or ask your pharmacist for the best ways to dispose of medications.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Entresto Interactions

Entresto can interact with a variety of medications, supplements, and even certain foods. These interactions can vary in their effects. Some may reduce the effectiveness of the medication, while others can increase the likelihood and severity of side effects.

Interactions with Other Medications

Before starting Entresto, it is crucial to discuss all medications you are currently taking with your doctor and pharmacist. This includes prescription drugs, over-the-counter medicines, and any vitamins, herbs, or supplements. Being open about your medication regimen helps prevent potential interactions. If you have any specific concerns or questions about how drug interactions might affect you, do not hesitate to ask your doctor or pharmacist for more information.

Interactions with Angiotensin Converting Enzyme (ACE) Inhibitors: Combining Entresto with an angiotensin-converting enzyme (ACE) inhibitor can increase your risk of angioedema, a severe type of allergic reaction. Therefore, it is advised not to take Entresto within 36 hours of using an ACE inhibitor, as this is the time needed for the ACE inhibitor to clear from your system. Some common ACE inhibitors include:

• Enalapril (Vasotec)
• Lisinopril (Zestril, Prinivil)
• Fosinopril
• Captopril
• Perindopril
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril

If you are currently taking an ACE inhibitor and are considering starting Entresto, it is crucial to discuss this with your doctor. They will guide you on the appropriate timing for transitioning between these two medications to minimize health risks.

Interactions with Angiotensin II Receptor Blockers (ARBs): Entresto is formulated with valsartan, a compound classified as an angiotensin II receptor blocker (ARB). This class of medication functions by blocking angiotensin II, a substance in the body that increases blood pressure. When Entresto is taken in conjunction with another ARB, it can lead to an excessive accumulation of ARB levels within the body. This elevation can significantly increase the likelihood of experiencing adverse effects associated with these medications. Common examples of ARBs include:

• Valsartan (Diovan)
• Losartan (Cozaar)
• Candesartan (Atacand)

Due to this potential for increased side effects, doctors usually do not prescribe another ARB if you are already taking Entresto. If you are currently on an ARB and are considering starting Entresto, consult your doctor. They will likely advise you to stop taking the ARB before beginning treatment with Entresto.

Interactions with Certain Diuretics: Diuretics, commonly referred to as water pills, are medications that help reduce the amount of fluid in your body. Among these, potassium-sparing diuretics prevent your body from eliminating potassium. Entresto can cause hyperkalemia, which is an elevated level of potassium in the blood. Therefore, combining Entresto with a potassium-sparing diuretic might further increase your potassium levels. Examples of potassium-sparing diuretics include:

• Spironolactone (Aldactone)
• Amiloride (Midamor)
• Triamterene (Dyrenium)
• Eplerenone (Inspra)

If you are using a potassium-sparing diuretic, it’s important to inform your doctor before starting treatment with Entresto. Your doctor will monitor your blood potassium levels to ensure they remain within a safe range during your treatment.

Interactions with Lithium: Combining Entresto with lithium (Lithobid) may cause lithium levels to increase to potentially unsafe levels in your body, leading to serious side effects. If you are taking both medications, your doctor will closely monitor your lithium levels and watch for any adverse effects. Adjustments to your lithium dosage might be necessary.

Interactions with Herbs and Supplements

There are no specific herbs or supplements known to interact with Entresto. However, it’s still important to consult your doctor or pharmacist before using any herbal or dietary supplements while you are on Entresto.

Interactions with Foods

There are no known food interactions with Entresto, meaning you can continue your usual diet unless your doctor advises otherwise.

[Note: This isn’t a complete list, and there could be other drugs that interact with Entresto. Make sure to tell your doctor or pharmacist about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Entresto Alternatives

• Corlanor (ivabradine)
• Zestril (lisinopril)
• Prinivil (lisinopril)
• Vasotec (enalapril)
• Epaned (enalapril)
• Accupril (quinapril)
• Altace (ramipril)
• Cozaar (losartan)
• Diovan (valsartan)
• Atacand (candesartan)
• Aldactone (spironolactone)
• Inspra (eplerenone)
• Lanoxin (digoxin)
• Fosinopril
• Captopril
• Perindopril
• Trandolapril

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Can I suddenly stop taking Entresto?

You can stop taking Entresto suddenly if your doctor advises it, as this is generally safe and doesn’t cause withdrawal symptoms. However, it’s important to remember that the symptoms of heart failure or the condition you were treating with Entresto might return if you discontinue the medication. Therefore, your doctor will likely suggest an alternative treatment to continue managing your condition effectively. Always consult your doctor before stopping Entresto or any other prescribed medication. An exception to this advice is if you become pregnant while taking Entresto, you should stop taking the medication immediately due to the risk of fetal harm and inform your doctor promptly to discuss alternative treatments.

Can I still exercise if I’m using Entresto?

Yes, you can definitely continue to exercise while taking Entresto. The American College of Cardiology suggests that people with heart failure can engage in a variety of activities, such as walking, rowing, cycling, climbing stairs, lifting weights, and bodyweight exercises. It’s crucial to consult your doctor to determine which exercises are most suitable for you. Staying active is an essential part of managing heart failure, and your doctor might recommend enrolling in a cardiac rehabilitation program. This program provides guidance from trained professionals who can help you exercise safely and effectively.

Can I use Entresto if I’m on dialysis?

Entresto has not been specifically studied in people with heart failure who are undergoing dialysis. Dialysis is a medical procedure that removes waste, excess water, and sometimes medications from your blood. Because of this, it is difficult to know how effective or safe Entresto is for patients on dialysis.

Additionally, Entresto binds strongly to proteins in the blood, which means it is not removed during the dialysis process. There is also a risk of serious kidney-related side effects, including kidney failure, when taking Entresto. If your kidney function is impaired and you are not on dialysis, your doctor may prescribe a lower dose of Entresto. Always consult your doctor for the most appropriate treatment advice for your specific health condition.

Will Entresto affect my BNP level?

Yes, Entresto can influence your B-type natriuretic peptide level. BNP is a hormone produced by your heart, and it is used along with another hormone called NT-proBNP to monitor heart failure through blood tests. Generally, when heart failure worsens, levels of BNP and NT-proBNP increase, and they decrease when heart failure is stable. These hormones don’t cause heart failure but serve as indicators to help your doctor assess the health of your heart and how well it’s responding to treatment with Entresto.

One of the active ingredients in Entresto, sacubitril, prevents the body from breaking down BNP, which can lead to increased BNP levels when you are taking the medication. However, sacubitril does not affect the breakdown of NT-proBNP, so levels of NT-proBNP may decrease during treatment. Your doctor will consider these effects when interpreting your test results to manage your heart failure effectively.

How long does it take to work?

After starting treatment with Entresto, it typically takes a few days before you might start observing any noticeable improvements in your symptoms of heart failure. The duration before these benefits become apparent can vary from person to person. Entresto functions by progressively enhancing the heart’s efficiency and function. Therefore, as the medication begins to take effect, it gradually improves the heart’s ability to pump blood more effectively, which can lead to a reduction in symptoms. However, the exact timeframe for experiencing these improvements can differ based on individual health conditions and the severity of heart failure.

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