What side effects are most common with Entresto (sacubitril/valsartan)?
Commonly reported side effects with Entresto include fatigue, dizziness, and low blood pressure (hypotension). Some people also report headache and increased potassium levels (hyperkalemia), especially if they take other medicines that raise potassium or have kidney problems. [1]
What serious side effects should patients watch for?
Entresto can cause or worsen several potentially serious problems:
- Angioedema (swelling of the face, lips, tongue, or throat). This can be life-threatening and requires urgent care. [1]
- Kidney function worsening, seen as changes in creatinine or reduced urine output. [1]
- Hyperkalemia (high potassium), which can lead to dangerous heart rhythm problems. [1]
Patients should seek medical attention promptly for symptoms such as fainting, severe dizziness, facial swelling, trouble breathing, or muscle weakness/palpitations. [1]
Can Entresto cause low blood pressure or dizziness?
Yes. Low blood pressure is a known risk and may feel like lightheadedness, dizziness, or fainting, especially when starting therapy or increasing the dose. This is more likely if you are dehydrated, take diuretics (“water pills”), or already have low baseline blood pressure. [1]
Does Entresto interact with other medicines in a way that affects side effects?
Entresto’s side effects can be amplified by certain drug combinations:
- Other blood pressure–lowering medicines can increase dizziness or hypotension risk. [1]
- Medicines that raise potassium (such as some diuretics, potassium supplements, or certain kidney-related therapies) can increase hyperkalemia risk. [1]
Also, Entresto must not be used with sacubitril/valsartan–adjacent therapies that increase bradykinin levels due to angioedema risk, and it has specific “washout” timing rules after stopping certain drugs. [1]
What about pregnancy, breastfeeding, and long-term safety concerns?
Heart failure patients who may become pregnant should discuss treatment early. Angiotensin receptor blockers (like valsartan in Entresto) can harm a developing fetus, so clinicians usually review pregnancy risk carefully and may switch therapy. If you are breastfeeding, ask your clinician what to do based on your situation and local guidance. [1]
Who is more likely to get Entresto side effects?
Side effects like hypotension, kidney-related changes, and hyperkalemia are more likely in people with:
- Kidney disease
- Higher baseline potassium
- Lower baseline blood pressure
- Dehydration or heavy diuretic use
- Use of other medications that affect potassium or blood pressure [1]
Are there alternatives if Entresto side effects are hard to tolerate?
If Entresto causes intolerable blood pressure drops, angioedema, or persistent lab abnormalities, clinicians may consider alternative guideline-based heart failure medicines tailored to the patient’s blood pressure, kidney function, and potassium level (for example, other drug classes used in heart failure). The best option depends on the specific side effect and lab results. [1]
Source
[1] https://www.drugs.com/sfx/entresto-side-effects.html