Unintentional weight loss of ~30 lb in the year after starting Entresto (sacubitril/valsartan) can happen, but it’s not one of the most common side effects. Since your weight is now stable, that’s reassuring—but it’s important to make sure the weight loss wasn’t from something else (heart failure progression, other meds, appetite changes, GI issues, cancer/infection, thyroid problems, etc.).
Could Entresto cause weight loss?
Entresto’s more typical side effects are things like low blood pressure, dizziness, kidney function changes, high potassium, and cough/angioedema (less commonly). Weight loss is not a headline/common effect, but:
- any medication that affects blood pressure and fluid status could indirectly reduce appetite or change how you feel,
- and side effects like GI upset (in some people) can contribute.
That said, with 30 pounds, I’d treat this as “needs a medical check,” even if it has stabilized.
Why you should still follow up
Because large unintentional weight loss can signal other problems, clinicians typically consider:
- Heart failure status (symptoms like worsening shortness of breath, fatigue, worsening edema or not)
- Kidney function / electrolytes (Entresto can affect kidneys and potassium)
- Blood pressure (too low can reduce appetite/activity)
- Other medications started around the same time (diuretics, diabetes meds like GLP-1s, thyroid meds, etc.)
- GI causes (chronic diarrhea, reflux/gastritis, swallowing issues)
- Infection or inflammatory disease
- Thyroid disease
- Malignancy (age-dependent screening)
What to ask your prescriber (practical next steps)
If you haven’t already discussed this, consider contacting your cardiologist/primary care to review:
- Timing: Did weight loss begin soon after starting Entresto?
- Current labs: recent BMP/CMP (creatinine, potassium), blood pressure readings
- Medication review: any changes to diuretics, diabetes meds, antidepressants, stimulants, etc.
- Whether you need basic screening labs such as:
- CBC, CMP
- TSH/free T4
- HbA1c (if relevant)
- ESR/CRP (sometimes)
- Urinalysis
- Plus targeted tests based on symptoms (and age-appropriate cancer screening)
When to seek care urgently
Get urgent medical attention if any of these are present now:
- blood in stool/vomit, black tarry stools
- persistent vomiting or inability to eat
- fever, night sweats
- new severe shortness of breath, chest pain, fainting
- signs of very low blood pressure (near-fainting, severe dizziness)
- rapid worsening weakness or dehydration
A couple of questions (so I can tailor advice)
- How old are you and what condition are you taking Entresto for (heart failure with reduced EF, etc.)?
- Did you start/adjust any other meds around the same time (especially diuretics, diabetes meds)?
- Any symptoms during the weight loss period (loss of appetite, diarrhea, nausea, trouble swallowing, cough, reflux, fatigue)?
- What are your most recent blood pressure and kidney/potassium labs?
If you share those details, I can help you think through the most likely causes and what follow-up is most reasonable.