Entresto (valsartan + sacubitril) 49 / 51 mg
The 49 / 51 mg tablets are the standard starting dose for most adults with HFrEF (heart‑failure with reduced ejection fraction).
| Step | Dose | Frequency | Typical Goal | When to Increase |
|------|------|-----------|--------------|------------------|
| Start | 49 mg + 51 mg | Twice daily | 100 % of daily dose | If blood pressure, kidney function, and potassium remain acceptable |
| Titrate | 97 mg + 103 mg | Twice daily | 100 % of daily dose | After 2–4 weeks, if tolerated |
| Maximum | 194 mg + 206 mg | Twice daily | 100 % of daily dose | Once tolerated, no further increase |
Key points to keep in mind
1. Titration schedule – Increase the dose every 2–4 weeks, monitoring blood pressure, serum creatinine, potassium, and symptoms.
2. Start‑up – Stop any ACE inhibitor 36 hours before the first Entresto dose to avoid angioedema.
3. Contraindications –
* Pregnancy (class X)
* Known hypersensitivity to valsartan or sacubitril
* Severe renal impairment (eGFR < 30 mL/min/1.73 m²)
* Hyperkalaemia (K⁺ > 5.5 mmol/L)
4. Side effects – Hypotension, dizziness, renal dysfunction, hyperkalaemia, cough (rare).
5. Drug interactions – Avoid other potassium‑sparing agents unless closely monitored.
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What might “pret” mean?
- “Pre‑treatment” – You might be asking about the precautions taken before starting Entresto. In that case:
* Discontinue ACE‑inhibitor 36 h prior.
* Check baseline blood pressure, creatinine, potassium, and ejection fraction.
- “Pretreatment” – Sometimes clinicians refer to pre‑treatment with an ACE‑inhibitor or ARB before switching to Entresto, but the same 36 h wash‑out rule applies.
If you had a different meaning in mind (e.g., “pretax” dosing, “pre‑exercise” considerations, etc.), just let me know and I’ll dig into that!
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Bottom line:
- Start at 49/51 mg BID, titrate up to 97/103 mg BID if tolerated, and monitor the usual labs and vitals.
- Watch for hypotension, renal function changes, and hyperkalaemia.
- If in doubt, discuss with your cardiologist or pharmacist.
This information is for educational purposes only and is not a substitute for professional medical advice.