Why Suddenly Stopping Entresto Isn’t A Good Idea (Plus, 4 Other Things to Know About Taking It)

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Entresto (sacubitril / valsartan) is a medication that treats heart failure. This oral medication has been shown to improve heart failure symptoms and reduce the risk of hospitalization and death related to heart failure in adults and children.

If your healthcare team recommends Entresto, it's helpful to know a few facts about how to take it - and why taking it consistently is important. Here, you'll learn answers to five frequently asked questions, including what can happen if you suddenly stop taking Entresto and how long you might need to take it for.

1. Stopping Entresto suddenly isn't usually a good idea

What happens if you suddenly stop taking Entresto? We don't have a lot of research that can help answer this question. But it's possible that stopping Entresto could worsen heart failure. Specifically, it could worsen left ventricular ejection fraction (LVEF). This is a measure of how well the heart works and how much blood it's able to pump with each beat. A lower LVEF means the heart isn't contracting as expected, so the rest of the body may not be receiving enough blood.

It's possible your prescriber may recommend replacing Entresto with another heart failure medication. In this case, they can help you safely transition medications so that your risk of side effects from stopping Entresto is lower.

Possible side effects of stopping Entresto treatment

Potential side effects of stopping Entresto (and not replacing it with another heart failure medication) include symptoms of worsening LVEF, such as shortness of breath, fatigue, and dizziness. So in most cases, stopping Entresto suddenly without a prescriber's approval isn't a good idea.

However, you may need to stop taking Entresto suddenly, even before talking with your prescriber, if you experience angioedema. Angioedema refers to swelling of the deep tissues. This is a rare but serious side effect associated with Entresto. It can present on the face (as lip or tongue swelling) or in the throat and neck. In severe cases, it can lead to difficulty breathing and become life-threatening.

If you experience any symptoms of angioedema, stop taking Entresto immediately and seek emergency care. You don't need to seek your prescriber's approval to stop taking Entresto if you're experiencing angioedema. Once you've been treated, you can talk with your prescriber about whether another heart failure medication may be a better option for you.

2. You may need to take Entresto indefinitely

To put it simply, most people need to take Entresto for a long time to reap the full benefits of the medication (as discussed below). So if you're wondering exactly how long to take Entresto, the answer is likely indefinitely - as long as you're tolerating it well.

Research supports the idea that taking heart failure medication for a long time, and often indefinitely, is the best approach. Studies show that stopping treatment with these medications too early leads to worse outcomes, such as a higher risk of hospitalization and death related to heart failure. Some research shows that stopping treatment can also cause a reversal in any improvements to LVEF.

However, some people may need to stop taking Entresto at some point. For example, if Entresto is causing other health issues, such as kidney damage, your prescriber may recommend stopping it. But you shouldn't make any changes without talking to them first.

If your prescriber recommends stopping treatment with Entresto, you don't need to taper your dosage. Rather, you can just stop taking it. It's possible that your prescriber will then recommend another heart failure medication to replace Entresto.

3. Entresto may start to lower blood pressure within a few hours, but its other heart benefits can take months

It takes about 2 hours for Entresto to start working after you take a dose. You may not feel differently, but you may notice a decrease in blood pressure levels. Though, the full benefits of Entresto take longer to materialize.

Here are summaries of findings from studies that looked at how long Entresto takes to work:

• Entresto reduces NT-proBNP over the course of a year. The PROVE-HF study found that Entresto reduced participants' N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels within 2 weeks of treatment. And participants' NT-proBNP levels continued to improve over the course of the study (12 months). NT-proBNP is a protein found in the heart. High levels can indicate heart failure. So checking NT-proBNP levels can help determine whether heart failure medications are working.

• Entresto improves ejection fraction over the course of a year. In the PROVE-HF study, participants' LVEF was measured after 6 months and 12 months of treatment. The study found that participants' LVEF improved by 6 months of treatment, and it further improved by 12 months of treatment.

• Entresto lowers the risk of hospitalization after 30 days of use. In the PARADIGM-HF study, which compared Entresto with the heart failure medication enalapril (Vasotec), Entresto lowered the risk of hospitalization due to heart failure within 30 days of treatment.

These studies support the idea that Entresto's full benefits can take a while to appear.

4. Entresto is most effective when taken twice a day

Entresto can stay in the body for over 2 days. But that doesn't mean it's working at its peak that entire time. After several hours, Entresto doesn't have as much of an effect on the body. This is why it's usually taken twice a day.

Though, it may seem more convenient to only take Entresto once a day, this won't help you receive its maximum benefits.

5. Entresto is considered safe, but it's a good idea to be aware of potential side effects

Entresto is generally considered safe and effective for treating heart failure in adults and children who are at least 1 year old. But like all medications, Entresto has potential side effects and drug interactions to be aware of.

Entresto interactions can be caused by:

• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Prinivil) or enalapril: Combining Entresto with these medications increases the risk of angioedema.

• Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar): Entresto itself contains an ARB (valsartan). Taking more than one ARB increases the risk of side effects.

• Aliskiren (Tekturna) in people with diabetes or kidney disease: For people with these health conditions, combining aliskiren and Entresto increases the risk of further kidney damage.

Examples of Entresto side effects include:

• Low blood pressure (hypotension)

• High potassium levels

• Cough

• Dizziness

• Kidney problems

As discussed above, Entresto can also cause angioedema in rare cases. So if you've had angioedema from an ACE inhibitor or ARB in the past, or you have hereditary angioedema, you shouldn't take Entresto.

Depending on your individual health history, Entresto may or may not be the best choice for you. Your prescriber can help you decide whether Entresto or another heart failure medication is the best option.

How to save on Entresto

Entresto is currently only available as a brand-name medication. The FDA approved a generic version of Entresto in May 2024, but it won't be available until the brand-name medication's first patent expires in July 2025 (at the earliest). In the meantime, there are a few ways to save on brand-name Entresto:

• Receive a free month of Entresto. Entresto's manufacturer offers a one-time, free 30-day supply of Entresto. Anyone can sign up for this free trial, regardless of insurance status.

• Use a manufacturer's savings card. If you have commercial insurance, you may be eligible to receive Entresto for as little as $10 per prescription with a copay savings card from the manufacturer.

• Enroll in a patient assistance program. If you're uninsured or underinsured, you may qualify for Entresto's patient assistance program. You could receive Entresto free of cost if you're eligible.

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