Entresto® for Heart Failure: Uses, Dosing, and Safety

What Entresto® Is and How It Works

Entresto is a prescription tablet that treats chronic heart failure with reduced ejection fraction (HFrEF). It combines sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker (ARB). This dual action lowers neurohormonal stress, reduces sodium and fluid retention, and eases the workload on the heart. Many people compare Entresto price, Entresto buy options, and Entresto without insurance costs when considering long-term therapy.

YouDrugstore is a licensed Canadian pharmacy headquartered in Manitoba, and every prescription is reviewed by a licensed pharmacist before dispensing.

Entresto is taken by mouth twice daily. It is used to reduce the risk of cardiovascular death and heart failure hospitalization. Sacubitril increases levels of natriuretic peptides, which support vasodilation and diuresis. Valsartan blocks the angiotensin II type‑1 receptor, which lowers vasoconstriction and aldosterone effects. Together, they help stabilize symptoms and support cardiac remodeling over time.

The product is available in fixed-dose strengths expressed as sacubitril/valsartan: 24/26 mg, 49/51 mg, and 97/103 mg. Tablets can be taken with or without food. An oral suspension may be prepared for patients who cannot swallow tablets, per the product instructions.

Entresto is not used with an ACE inhibitor. A 36‑hour washout is required when switching from an ACE inhibitor to Entresto to lower the risk of angioedema. It should not be used during pregnancy.

Dosage and Usage

• Starting dose for most adults previously on moderate/high doses of ACE inhibitor or ARB: 49/51 mg twice daily.
• Lower starting dose 24/26 mg twice daily for patients naïve to ACE inhibitor/ARB, the elderly, those with moderate hepatic impairment, or severe renal impairment.
• Titrate every 2–4 weeks to the target 97/103 mg twice daily as tolerated.
• Allow a 36‑hour washout after stopping an ACE inhibitor before the first Entresto dose.
• Do not use with another ARB, aliskiren (in diabetes), or an ACE inhibitor.
• Swallow tablets whole with water. Food is optional.
• If a dose is missed, take the next dose at the regular time. Do not double up.
• Blood pressure, kidney function, and potassium should be monitored during dose changes.

• Store tablets at 20–25 °C (68–77 °F); excursions 15–30 °C (59–86 °F) are acceptable.
• Keep tablets in the original bottle or blister to protect from moisture.
• Do not freeze. Keep away from heat, humidity, and direct sunlight.
• When you travel, carry Entresto in your hand luggage with the pharmacy label.
• Use a pill organizer only if kept dry and within the temperature range.
• Keep out of reach of children and pets.

Benefits and Savings

In clinical trials, Entresto reduced cardiovascular death and heart failure hospitalization compared with enalapril. Patients often report improved exercise tolerance and fewer symptoms over time. Twice‑daily dosing supports steady coverage of neurohormonal pathways.

Ordering through Canadian pricing can lower the Entresto cost. Typical savings are 60–80% versus many US retail prices. Multi‑month supplies and occasional bulk promotions may reduce the per‑month Entresto tablets price, and this can be helpful for those paying Entresto cash price or managing Entresto without insurance.

We work with licensed, vetted international partner pharmacies to source authentic brand medicines with a broad selection at sensible prices.

For current promotions, see our Entresto coupon page.

Side Effects and Safety

• Low blood pressure, dizziness, or lightheadedness, especially after starting or increasing the dose.
• Cough or fatigue.
• Increased potassium (hyperkalemia), which may cause weakness or heart rhythm changes.
• Kidney function changes, especially in those with pre‑existing kidney disease or dehydration.
• Headache or gastrointestinal discomfort.

Serious risks include angioedema (swelling of the face, lips, tongue, or throat), which is more likely in those with prior angioedema from ACE inhibitors or ARBs. Fetal toxicity is a known risk, so avoid during pregnancy and discontinue if pregnancy occurs. Use caution with severe hepatic impairment. Monitor more closely when combined with nonsteroidal anti‑inflammatory drugs (NSAIDs) or potassium‑sparing agents. Lithium levels may increase; monitoring is advised if used together.

Onset Time

Blood pressure reductions may appear within the first week. Symptom relief, such as less shortness of breath or reduced edema, may emerge over 1–2 weeks as dose titration progresses. Structural heart benefits and risk reduction accumulate over months, with target dosing reached by 4–8 weeks in many patients when tolerated.

Compare With Alternatives

ACE inhibitors such as enalapril were a standard cornerstone of HFrEF therapy for years. Entresto was shown to provide superior outcomes to enalapril in a large randomized trial, which is why many guidelines recommend switching appropriate patients to an ARNI from an ACE inhibitor.

ARBs like valsartan alone may be considered when ACE inhibitors are not tolerated. Entresto pairs valsartan with sacubitril for additional neprilysin inhibition, which may yield greater reductions in hospitalization risk than an ARB alone.

SGLT2 inhibitors are now a key part of HFrEF care regardless of diabetes status. Agents such as Jardiance® (empagliflozin) and Forxiga® (dapagliflozin) reduce heart failure hospitalization and help preserve kidney function. These may be combined with Entresto when appropriate.

Combination Therapy

• Beta‑blocker (e.g., carvedilol, metoprolol succinate): foundational therapy; start low and titrate.
• Mineralocorticoid receptor antagonist (spironolactone or eplerenone): monitor potassium and kidney function.
• SGLT2 inhibitor: can be added for further risk reduction in HFrEF.
• Loop diuretic (e.g., furosemide): for congestion; adjust to symptoms and weight.
• Ivabradine: consider if heart rate remains elevated despite beta‑blocker.
• Avoid concurrent ACE inhibitor; ensure a 36‑hour washout when switching to Entresto.

Patient Suitability and Cost-Saving Tips

Entresto is generally used in adults with symptomatic HFrEF (often NYHA class II–III). It may be considered in some pediatric patients under specialist supervision. It is not intended for patients who are pregnant, have a history of angioedema on ACE inhibitors or ARBs, or who require ACE inhibitor therapy. Use caution with severe renal impairment, moderate hepatic impairment, or low baseline blood pressure. Regular laboratory monitoring supports safe titration.

To manage costs, consider a larger supply if the dose is stable. Multi‑month fills can lower per‑month Entresto tablets cost when promotions apply. You can set gentle reorder reminders in your account so you never run short. Patients comparing Entresto cash pay options often see better value through Canadian pharmacy pricing for Entresto without insurance.

Authoritative Sources

Novartis Entresto product information

Health Canada Drug Product Database: Entresto

US FDA Prescribing Information for Entresto

Order Entresto® from Youdrugstore: add to cart, upload your prescription, and we ship with prompt, express, cold-chain handling.

This content is for educational purposes and does not replace advice from your healthcare professional. Always follow your prescriber’s directions for your own care.