Sacubitril: Description, Uses, Side Effects, Interactions, Precautions, Dosage and Storage

It is a medicine that treats heart failure.

It is used to reduce the risk of death and hospitalization in people with certain types of long-lasting heart failure .

Description of sacubitril

Its generic name is Entresto. This is a unique product that contains sacubitril and valsartan.

Sacubitril belongs to a group of medicines called neprilysin inhibitors . These work to control blood volume and lower blood pressure.

Valsartan belongs to a group of medicines called angiotensin II receptor antagonists, which help the blood vessels to relax.

This medication comes in tablet form and is typically taken twice a day.

Common side effects include low blood pressure, high potassium levels in the blood, and poor kidney function.


Sacubitril is a prescription medicine used to treat heart failure in adults.

It is used to reduce the risk of death and hospitalization in people with certain types of long-lasting heart failure.

Heart failure occurs when the heart is weak and cannot pump enough blood to the lungs and the rest of the body.

Side effects of sacubitril

Serious side effects have been reported with the use of sacubitril. Common side effects include:

  • Low blood pressure.
  • High levels of potassium in the blood.
  • Poor kidney function

Serious side effects include:

  • Serious allergic reactions that cause swelling of the face, lips, tongue, and throat (angioedema) that can cause breathing problems and death.
  • Low blood pressure ( hypotension ) which can be more common when combined with water pills.
  • Kidney problems
  • Increase in the amount of potassium in your blood.

Regarding this, it is necessary to get emergency medical attention immediately if the patient has symptoms of angioedema or shortness of breath.

Taking sacubitril again is not recommended if the patient has had angioedema while on treatment.

People who have had angioedema before taking sacubitril may have a higher risk of getting angioedema than people who have not had angioedema before.

The patient should call their doctor if they become dizzy or if they develop extreme fatigue.

On the other hand, the doctor must monitor the kidney function of the patient for the duration of the treatment.

If the patient shows changes in kidney function tests, he may need a lower dose of sacubitril or may need to stop taking it for a period of time.

Also, your doctor should monitor your blood potassium level during treatment.


The patient should tell their doctor about all the medications they are taking, including prescription and non-prescription drugs, vitamins, and herbal supplements.

Sacubitril and other medications can affect each other. It is always advisable to consult with a doctor before starting or stopping any medication.

Especially, it is important for the patient to tell the doctor if he takes an ACE inhibitor (blood pressure lowering drugs) such as:

  • Benazepril (Lotensin , Lotensin HCT).
  • Captopril (Capoten, Capozide).
  • Enalapril (Vasotec , Floreal).
  • Fosinopril (Monopril, Monopril HCT).
  • Lisinopril (Prinivil, Prinzide, Zestril, Zestoretic).
  • Moexipril (Univasc, Uniretic).
  • Quinapril (Accupril, Accuretic, Quinaretic).
  • Ramipril (Altace).
  • Trandolapril (Mavik, Tarka).

You should also report if you take an angiotensin II receptor blocker (ARB), such as:

  • Azilsartan (Edarbi).
  • Candesartan (Atacand).
  • Irbesartan (Avapro).
  • Losartan (Cozaar).
  • Olmesartan (Benicar).
  • Telmisartan (Micardis, Twynsta).
  • Valsartan (Diovan).

It is also important to report if the patient has diabetes and takes a drug called Aliskiren.

Aliskiren like Entresto can lower blood pressure, can increase potassium in the blood, and can cause poor kidney function.

If the patient takes diuretics (water pills) it is necessary to inform their doctor, since they can increase their potassium in the blood, these can be:

  • Espironolactona (Aldactona).
  • Triamtereno (Dyrenium).
  • Amilorida (Midamor).

If you take non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 inhibitors (COX-2 inhibitors) it is important to mention this.

NSAIDs and COX-2 inhibitors like Entresto can also cause poor kidney function. NSAIDs and COX-2 inhibitors include:

  • Ibuprofeno (Advil, Motrin).
  • Naproxen (Aleve, Naprosyn).
  • Salsalate (Amigesic).
  • Celecoxib (Celebrex).
  • Diclofenac (Voltaren).
  • Etodolac (Lodine).
  • Indometacina (Indocin).
  • Ketoprofeno (Orudis).
  • Ketorolaco (Toradol).
  • Nabumetona (Relafen).
  • Oxaprozin (Daypro).
  • Piroxicam (Feldene).
  • Sulindac (Clinoril).
  • Tolmetina (Tolectina).

Finally, if the patient takes lithium, it is very important that they consult their doctor before taking sacubitril. Sacubitril can cause lithium toxicity. Lithium is a medicine used to:

  • Treat and prevent episodes of mania (abnormally excited mood).
  • People with bipolar disorder (a mood disorder or changes from normal mood to an abnormally excited mood).

A physician must monitor the patient’s blood lithium levels with a laboratory test and may adjust his lithium dose to avoid toxicity.

You need to make sure you do the lab test when a doctor prescribes it.

Sacubitril precautions

The patient should not take sacubitril if:

  • You are allergic to some of the ingredients of sacubitril or valsartan.
  • Had allergic reactions, including swelling of the face, lips, tongue, throat, or difficulty breathing while taking ECA or ARB.
  • Take an ACE inhibitor medicine.
  • You have diabetes and take a medicine that contains Aliskiren.

It is important to mention that sacubitril should not be taken for at least 36 hours before or after taking an ACE inhibitor medicine.

The patient should consult his doctor or pharmacist before taking sacubitril if he is not sure if he is taking an ACE inhibitor medicine.

Interactions with food

All medications can interact with certain foods.

In the case of sacubitril, salt substitutes containing potassium should be avoided as they can cause high levels of potassium in the blood (hyperkalemia).

The patient should contact their doctor immediately if they experience any of the following symptoms of high potassium levels in the blood:

  • Soft spot.
  • Irregular heartbeat
  • Confusion.
  • Tingling in the toes and fingers.
  • Feeling of heaviness in the legs.

Sacubitril during pregnancy

The patient should inform her doctor if she is pregnant or planning to become pregnant as sacubitril can harm or cause death to the baby.

The patient should discuss other ways to treat heart failure with her doctor if she plans to become pregnant.

If the patient becomes pregnant while taking sacubitril, she should inform her doctor immediately.

Sacubitril during lactation

The patient should inform her doctor if she is breastfeeding or if she plans to breastfeed, as it is not known whether sacubitril crosses with human milk.

However, many drugs can pass into human milk, creating the possibility of serious adverse reactions in infants with the use of drugs.

This is why the decision must be made to stop breastfeeding or discontinue the use of sacubitril. The doctor and the patient will decide if the benefits outweigh the risk of using sacubitril.

How to use

The patient should take the medicine exactly as his doctor tells him to take it.

Sacubitril comes in tablet form and is taken twice a day. The dose may be changed by the doctor during the treatment period.

It is recommended to take sacubitril with water. The tablets should not be chewed, divided or broken.

If the patient takes too much of this drug (more than prescribed), they should call their doctor immediately.

If you miss a dose, you should take the missed dose as soon as you remember.

However, if it is almost time for the next dose, the patient should skip the missed dose and take their next dose at the usual time.

Taking two doses of sacubitril at the same time is not recommended.


The directions on the prescription label should be followed carefully.

The dose recommended by the doctor should be based on the following:

  • The condition being treated.
  • Other medical conditions that the patient has.
  • Other medications the patient is taking.
  • How the patient responds to this medicine.

The recommended starting dose of sacubitril is 49 to 51 mg twice a day.

The doctor may double the dose after 2 to 4 weeks to the target maintenance dose of 97 to 103 mg twice a day, depending on the patient’s response to the drug.

However, the recommended starting dose of sacubitril is 24 to 26 mg twice a day if the patient:

  • You are not taking an ACE inhibitor or an ARB.
  • Taking previously low doses of any of these medications.
  • You have poor kidney and / or liver function.

Under these conditions, the doctor can double the dose after 2 to 4 weeks to the target maintenance dose of 97 to 103 mg twice daily.


If the patient takes too much of this medication, they should call their healthcare provider or local poison control center.

The most common sign and symptom associated with sacubitril overdose is hypotension.

Sacubitril lowers blood pressure. The patient may feel very lightheaded, dizzy, or develop extreme fatigue. If you experience this, you should seek medical help immediately.

Storage form of sacubitril

  • It is recommended to store the medicine at room temperature between 68 ° F and 77 ° F (20 ° C to 25 ° C).
  • The tablets must be protected from moisture.
  • It is necessary to keep the tablets in the original container.
  • All doctor and laboratory appointments must be kept. The doctor will order laboratory tests to check blood potassium levels, kidney function, and liver function.
  • It is recommended to keep the medicine out of the reach of children.