Sacubitril/Valsartan

About Sacubitril/Valsartan

Sacubitril becomes a drug in the body that blocks neprilysin, an enzyme that breaks down natriuretic peptides, which help the body get rid of salt and water; valsartan blocks the receptor for angiotensin II. In adults with chronic heart failure it lowers the risk of cardiovascular death and heart failure admissions, most clearly when ejection fraction is below normal.

It is used instead of an ACE inhibitor or ARB. After the last ACE inhibitor dose there is a 36-hour wait, because the combination raises the risk of angioedema, swelling of the face, lips, tongue or throat. Angioedema is more common in Black patients, and anyone who has had it with an ACE inhibitor or ARB must not take this drug.

Low blood pressure, high potassium, cough, dizziness and worsening kidney function are the most common side effects, so these are checked as the dose is doubled at intervals of two to four weeks toward the top strength. The boxed warning is about pregnancy: it can injure or kill a developing baby and is stopped as soon as pregnancy is detected. Breastfeeding is not recommended.

Its valsartan is absorbed better than ordinary valsartan tablets, so the strengths cannot be swapped milligram for milligram with plain valsartan. Children from one year old with heart failure from a weak left ventricle can take it; for those under 40 kg the label recommends Entresto Sprinkle pellets on soft food or a suspension the pharmacy makes from tablets.

Taking Sacubitril/Valsartan

How to take it

Twice a day, with or without food. Sprinkle capsules are opened and the contents sprinkled on a teaspoon or two of soft food, such as applesauce, and eaten straight away; the pellets are not crushed, chewed or given through a feeding tube.

If you miss a dose

Take it when you remember, unless the next dose is nearly due; then skip the missed dose. Do not take a double dose to make up for it.

Storage

Tablets at room temperature, away from heat and moisture. A suspension made by the pharmacy keeps up to 15 days at room temperature and must not be refrigerated.

Interactions to know about

Not with an ACE inhibitor or within 36 hours of one, or with aliskiren in people with diabetes; other ARBs are avoided. Potassium supplements, potassium salt substitutes and potassium-sparing diuretics can raise potassium too high, anti-inflammatories can worsen kidney function, and it raises lithium levels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Sacubitril/Valsartan differs from pharmacy to pharmacy

Until mid-2025 every pharmacy bought the same brand at a similar cost and quotes differed mainly by margin. Now a pharmacy dispensing a generic can quote far below one still dispensing Entresto, and while a drug is newly generic, prices between generics also vary widely. The Sprinkle pellets remain brand only, and a suspension made from tablets may carry a preparation charge.

Ways to pay less for Sacubitril/Valsartan without insurance

• Make sure the prescription allows generic substitution.
• Ask each pharmacy whether it dispenses a generic or the brand before comparing quotes.
• Once the dose is stable, ask for a ninety-day supply.
• For the Sprinkle pellets, ask whether the manufacturer offers a program you qualify for.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Sacubitril/Valsartan

1. 1.Is this a generic or the brand?
2. 2.How long after my last ACE inhibitor dose can I start?
3. 3.Should I stop my other valsartan or ARB tablets?
4. 4.Which symptoms of low blood pressure or facial swelling need urgent care?
5. 5.When will my potassium and kidney function be checked?

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