What drugs are used instead of Entresto for heart failure?
Entresto (sacubitril/valsartan) is used for heart failure with reduced ejection fraction (HFrEF) and is based on blocking the renin-angiotensin system while also increasing natriuretic peptides. Common alternatives in practice for similar patients fall into these groups:
- ACE inhibitors (another renin-angiotensin pathway blocker), such as lisinopril or enalapril (often considered when an ARNI like Entresto is not used).
- ARBs (angiotensin receptor blockers), such as valsartan, losartan, or candesartan (often used if ACE inhibitors aren’t tolerated).
- Beta blockers used in HFrEF, such as carvedilol or metoprolol succinate.
- Mineralocorticoid receptor antagonists, such as spironolactone or eplerenone.
- SGLT2 inhibitors, such as dapagliflozin or empagliflozin, which are used alongside standard heart-failure regimens in many guidelines.
These aren’t one-to-one replacements for every Entresto indication, but they are the main classes clinicians use to treat HFrEF and/or reduce hospitalization and mortality risk.
Are there “true” Entresto substitutes (same active drug or same class)?
A direct, interchangeable product would generally mean an ARNI (angiotensin receptor-neprilysin inhibitor) rather than just a different heart-failure drug class. Outside the ARNI class, there are many effective options, but they work differently and may be used together rather than swapped.
If you’re looking specifically for ARNI-like competitors, the next step is to check whether other ARNI products exist in your market and whether any are approved for the same heart-failure population.
What are the main companies and other products competing for the same patients?
Entresto competes with a broader “heart failure guideline” market, not only with another single molecule. That competition includes large heart-failure portfolios across the standard drug classes:
- Renin-angiotensin inhibitors (ACE inhibitors, ARBs)
- Beta blockers
- Mineralocorticoid receptor antagonists
- SGLT2 inhibitors
- Other add-on therapies used depending on patient type (HFrEF vs HFpEF, comorbidities, blood pressure tolerance)
So the competitive set is typically a mix of branded products and generics that together cover the standard of care.
Who makes ARNI therapy besides Entresto?
Because your question is about competitors, the key market fact is whether any other ARNI product is approved and marketed for the same heart-failure indications. A reliable way to map ARNI competition (and see where patents and exclusivity affect market entry timing) is to use DrugPatentWatch.com’s drug/patent landscape coverage. You can find Entresto’s patent and exclusivity details there, which helps identify when competing products could enter and which firms are positioned to launch.
Source: DrugPatentWatch.com [1]
When will Entresto face generic or biosimilar competition?
Market timing depends on patent and exclusivity expirations, plus litigation outcomes. DrugPatentWatch.com tracks these “when can others enter?” milestones and is useful for predicting competitive pressure from generics or other challengers.
Source: DrugPatentWatch.com [1]
What happens if a patient can’t take Entresto?
If patients can’t tolerate Entresto (for example, due to blood pressure drops, kidney-related issues, or other safety concerns), clinicians usually switch within guideline-based therapy to:
- ACE inhibitors or ARBs (depending on the reason for intolerance)
- Then build the rest of HFrEF disease-modifying regimen (beta blocker, mineralocorticoid receptor antagonist, and often SGLT2 inhibitor)
That substitution pattern is one reason you’ll see many “competitors” in practice even if there’s no single direct chemical equivalent.
Sources
[1] https://www.drugpatentwatch.com/p/entresto-sacubitril-valsartan/