Generic Entresto

Generic Entresto (sacubitril/valsartan) is finally on the market! Although the FDA approved generics of Entresto in 2023, legal disputes between the brand-name company Novartis and the generic manufacturer (MSN Pharmaceuticals) delayed its availability until mid-2025. Now that those restrictions have expired, Marley Drug is among the first pharmacies to offer this cost-effective alternative.

What is Entresto?

Entresto is a prescription medication used to treat heart failure in both adults and children aged 1 year and older. It combines two active ingredients, sacubitril and valsartan, that work together to help the heart function more efficiently.

The medication is specifically designed for patients with chronic heart failure, particularly those whose heart's ability to pump blood is reduced (called reduced ejection fraction). By reducing strain on the heart, Entresto has been clinically proven to lower the risk of death and hospitalization due to heart failure.

What Study Says

• 20% reduction in cardiovascular death or hospitalization compared to enalapril (an ACE inhibitor)
• Improved survival rates in large clinical studies
• Better heart function improvement measured by ejection fraction
• Reduced hospital stays for heart failure patients

In the landmark PARADIGM-HF trial involving thousands of patients, those taking Entresto lived longer and stayed out of the hospital more often than those taking traditional ACE inhibitors.

How Entresto Differs from Other Heart Failure Medications

Unlike many other heart failure or blood pressure medications, Entresto (sacubitril/valsartan) has a unique dual-action approach:

• Valsartan (ARB) blocks a hormone [angiotensin II] that tightens blood vessels and causes fluid retention.
• Sacubitril (neprilysin inhibitor) boosts substances in your body [natriuretic peptides] that relax blood vessels, lower blood pressure, and reduce excess fluid.

Think of it as turning off the "bad stuff" while keeping the "good stuff" working. This dual mechanism treats heart failure from multiple angles.

What is Entresto Used For?

Entresto is prescribed for:

• Adults with chronic heart failure to reduce the risk of cardiovascular death and hospitalization, especially in those with reduced heart pumping ability [low LVEF].
• Children aged 1 year and older with symptomatic heart failure due to systemic left ventricular systolic dysfunction, helping improve heart function over time.

How to Take It

Entresto is usually taken twice daily, with or without food. It comes in different tablet strengths:

• 24/26 mg (sacubitril/valsartan)
• 49/51 mg
• 97/103 mg

For children or adults who have trouble swallowing pills, Entresto is available as oral pellets called “Entresto Sprinkle.”

What if I miss a dose? Take it as soon as you remember. If it's almost time for your next dose, skip the missed one. Never double up to make up for a missed dose.

Side Effects

Common side effects:

• Low blood pressure (dizziness or lightheadedness)
• High potassium levels
• Dry cough
• Dizziness or fatigue
• Changes in kidney function

Serious but less common side effects:

• Angioedema: Swelling of face, lips, tongue, or throat that may affect breathing - requires immediate medical attention
• Worsening kidney function, especially in patients with existing kidney disease
• Very high potassium levels that can affect heart rhythm

Your healthcare provider will monitor your blood pressure, kidney function, and potassium levels while you take Entresto to ensure it’s safe and effective.

Important Drug Interactions

Entresto should NOT be taken with:

• ACE inhibitors (like Lisinopril) - wait at least 36 hours after your last ACE inhibitor dose
• Other ARBs (like Losartan) - increases risk of side effects
• Aliskiren (if you have diabetes)
• NSAIDs (like Ibuprofen)

Pregnancy and Breastfeeding: Entresto may cause fetal harm and should be stopped as soon as pregnancy is detected. It's also not recommended while breastfeeding.