ENTRESTO

Entresto is a brand name for a generic medication that combines Sacubitril and Valsartan. It is a prescription drug for heart failure with reduced ejection fraction (HFrEF) in adults. In 2015, the US FDA approved Entresto as a breakthrough treatment for heart failure.

Entresto is a combination medication containing two active ingredients: Sacubitril and Valsartan. Sacubitril/Valsartan works through a unique dual mechanism of action.

Sacubitril is a blood pressure medicine that increases the level of specific proteins in the body that can widen blood vessels. This contributes to lowering blood pressure by decreasing sodium levels.

On the other hand, Valsartan acts as an angiotensin II receptor blocker (ARBs), preventing blood pressure from narrowing, lowering blood pressure, and thereby improving blood flow. It works by relaxing the blood vessels so that blood can flow more easily, making the heart pump blood with ease.

Entresto is prescribed in adults dealing with chronic heart failure. It helps lower the risk of getting hospitalized when the symptoms get worse and reduces the risk of death from heart failure. Additionally, Entresto is used in the treatment of heart failure in children aged one year or above. 

The chemical designation for sacubitril/valsartan is a bit more complex due to its dual-component nature: Sacubitril is designed as (2S,4R)-5-(Biphenyl-4-yl)-4-((2S,5S)-2-(2,5-dimethyl phenyl)-5-(4-(trifluoromethyl)phenyl) tetrazole-5-yl)-2-methyl pentanoic acid hemicalcium salt. Valsartan is chemically represented as (S)-N-(1-carboxy-3-phenylpropyl)-L-valine.

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Entresto belongs to a class of Angiotensin receptor blockers and Neprilysin inhibitors (ARNI). It is a combination of sacubitril and valsartan. Sacubitril is a neprilysin inhibitor, and valsartan is an angiotensin II receptor blocker. It works by relaxing the blood vessels so that blood can flow more easily and makes the heart pump blood more easily.

It promotes vasodilation and also reduces blood pressure. The medicine provides a unique therapeutic approach for treating heart failure with reduced ejection fraction.

The commonly available strength of Entresto is:

• 24/26 mg, which contains 24 mg sacubitril/ 26 mg valsartan
• 49/51 mg, which contains 49 mg sacubitril/ 51 mg valsartan
• 97/103 mg, which contains 97 mg sacubitril/ 103 mg valsartan.

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HFrEF is a condition in which the heart's ability to pump blood effectively is affected, leading to symptoms like shortness of breath, fatigue, fluid retention, and increased risk of hospitalization in affected people.

Entresto is a medication used for heart failure with reduced ejection fraction or HFrEF. It belongs to the Angiotensin receptor blockers and Neprilysin inhibitors class- a combination of sacubitril and valsartan. These two medications help the blood vessels to relax, which allows the blood to flow more easily, making it easier for the heart to pump blood.

The medicine also reduces the risk of cardiovascular death and heart failure in people with HFrEF.

Usual adult dose for congestive heart failure:

• Starting dose: The initial or starting dose is 49/51 mg, which contains 49 mg sacubitril/ 51 mg valsartan orally twice daily.
• Target dose: The typical target dosage of Entresto is 97/103 mg oral tablet which is taken twice daily. It is also the maximum dosage of Entresto.

Usually, the doctor will start with a low dose; then, the dosage can be adjusted over time to reach the right amount for the patient.

Entresto is administered orally, which means it is taken by mouth as oral tablets. The tablet is used to treat specific types of heart failures. It may help in increasing the life cycle and reduce the chances of visiting the hospital for heart failure.

Do not exceed the recommended dose, as it can result in adverse reactions. It is essential to follow the prescribed dosage and the instructions given by the doctor. Use this medication as prescribed to get optimal results.

Common side effects of Entresto may include:

• Kidney problems such as changes in the amount of urine.
• High-potassium-like muscle weakness, slow heartbeat.
• Dizziness
• Cough
• Nausea
• Diarrhea
• Drop in blood pressure.
• Increase in serum creatinine levels.

Severe side effects may include:

• Rash
• Itching
• Severe dizziness
• Trouble breathing

Some of the drugs, products, and pills that are known to interact with Entresto include:

• Aliskiren
• Lithium
• Finer enone
• Enalapril
• Any other heart or blood pressure medicine.
• Diuretic or “water pill".
• Potassium-containing medicines
• NSAIDs like aspirin, ibuprofen, naproxen, celecoxib, diclofenac, indomethacin, meloxicam, and others.

Before initiating the Entresto tablets, a few precautions are needed to be considered, which are:

• Unless the doctor recommends it, potassium supplements or salt substitutes should be avoided while using Entresto.
• Avoid drinking alcohol as it lowers blood pressure and may increase the chances of certain side effects of Entresto.
• Consult the doctor if you have liver disease, kidney disease, or any serious allergic conditions before taking Entresto.

For the safe and effective use of Entresto, it is crucial to follow the given precautions:

• Avoid the intake of high-sodium food such as processed foods, canned soups, salty snacks, and fast foods, as it can lead to fluid retention and worsen heart failure symptoms.
• Taking Entresto can affect potassium levels in the body. Hence, it is important to avoid consuming excessive amounts of potassium-rich foods such as bananas, oranges, potatoes, and spinach, as they affect potassium levels in the body.
• Avoid the intake of grapefruit or grapefruit juice.
• Avoid smoking and alcohol consumption.
• One must avoid being pregnant while taking Entresto.
• Avoid taking this medicine if one is pregnant or breastfeeding.
• While taking Entresto must avoid taking any other medicine for high blood pressure or heart failure that belongs to a class of angiotensin-converting enzyme inhibitors.
• Avoid driving while taking this medicine, as it can cause e dizziness or tiredness in some people.

To ensure proper storage of Entresto, follow these guidelines:

• Keep it at a controlled room temperature between 20-25 degrees Celsius.
• Keep it away from excessive heat, direct sunlight, and moisture.
• Keep it out of reach of children and pets.
• Keep the medication in its original container with the lid tightly closed.

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