Does Entresto slow heart rate (bradycardia)?
Entresto (sacubitril/valsartan) is not usually classified as a medication that directly “slows the heart rate” in the way beta-blockers or some other heart-rate–lowering drugs do. Its main effects come from improving blood flow and reducing strain on the heart in heart failure, not from primary heart-rate suppression.
That said, patients can still experience heart-rate changes while taking Entresto. If your resting heart rate drops significantly or you have symptoms like dizziness, fainting, unusual fatigue, or worsening shortness of breath, clinicians typically check for contributing causes and whether another medication (such as beta-blockers, ivabradine, or certain calcium-channel blockers) is driving the bradycardia.
What heart-rate effects have been seen with Entresto?
In practice, any bradycardia reported in people taking Entresto is usually considered an indirect or variable effect rather than the drug’s main, intended action. Heart-rate lowering is more commonly tied to:
- Background heart-failure therapy (especially beta-blockers)
- Rate-control medications for atrial fibrillation
- Dehydration, low blood pressure, kidney function changes, or electrolyte issues that can lower heart rate indirectly
If you track your pulse after starting or increasing Entresto and see a consistent downward trend, it’s important to tell your prescribing clinician so they can review your overall regimen and vitals.
Could Entresto lower heart rate indirectly through blood pressure?
Yes. Entresto can lower blood pressure as part of its vasodilating and heart-failure benefits. When blood pressure drops, some people feel lightheaded or fatigued, and their overall cardiovascular compensation can change—including pulse rate. This doesn’t mean Entresto is a primary “rate-slowing” drug, but blood pressure effects can coincide with heart-rate changes.
When should you get medical help?
Seek urgent care or contact your clinician promptly if you have:
- Fainting or near-fainting
- Chest pain, severe shortness of breath, or confusion
- A very low pulse that persists (especially if symptomatic)
- New or worsening symptoms after starting or increasing Entresto
What else could be slowing your heart rate besides Entresto?
If you’re taking Entresto and your heart rate is lower than usual, common culprits include:
- Beta-blockers (metoprolol, carvedilol, bisoprolol)
- Ivabradine
- Diltiazem or verapamil
- Digoxin
- Overlap of multiple blood pressure/heart-function–lowering drugs
A clinician can help determine whether Entresto is responsible or whether another medication is the more likely driver.
If you tell me your age, the reason you were prescribed Entresto (HFrEF vs other), your typical resting pulse before/after starting, and any other heart meds you take, I can help you narrow down the most likely cause.