See the DrugPatentWatch profile for entresto
Common Side Effects of Entresto
Entresto (sacubitril/valsartan) commonly causes low blood pressure, high potassium levels (hyperkalemia), cough, dizziness, and kidney problems. These occur in more than 1 in 10 patients and often lead to dose adjustments or monitoring.[1]
Serious Side Effects Patients Report
Angioedema (swelling of face, lips, tongue, or throat) affects about 1 in 100 users and requires immediate medical attention. Fetal toxicity makes it unsafe during pregnancy, as it can harm the fetus. Worsening kidney function or heart failure symptoms also prompt urgent care.[1]
Side Effects by Frequency
- Very common (>10%): Hypotension, hyperkalemia, renal impairment.[1]
- Common (1-10%): Dizziness, cough, diarrhea, gastritis, elevated creatinine.[1]
- Uncommon (0.1-1%): Angioedema, postural dizziness.[1]
- Rare (<0.1%): Anaphylaxis-like reactions.[1]
Patients often ask about fatigue or headache; these are less frequent but noted in trials.
Why These Side Effects Happen
Sacubitril inhibits neprilysin to boost natriuretic peptides, while valsartan blocks angiotensin II. This dual action relaxes blood vessels (causing hypotension) and retains potassium (risking hyperkalemia). Cough stems from bradykinin buildup, similar to ACE inhibitors.[1]
How Long Do Side Effects Last?
Most like dizziness or cough improve within weeks as the body adjusts. Persistent hypotension or kidney issues may need dose reduction from 97/103 mg twice daily to 49/51 mg. Hyperkalemia requires blood tests.[1]
Risks for Specific Groups
Elderly patients face higher hypotension and renal risks. Those with kidney disease, diabetes, or on potassium supplements need close monitoring. Avoid in pregnancy (Category D); use contraception.[1]
Entresto vs. ACE Inhibitors Side Effects
Entresto has less cough (12% vs. 17% for enalapril) but similar angioedema risk—do not combine with ACE inhibitors (wait 36 hours).[1]
[1]: Entresto Prescribing Information (Novartis)
[2]: Drugs.com - Entresto Side Effects