Sacubitril/valsartan (Entresto)
For adults with heart failure and a reduced ejection fraction (HFrEF)
This two-in-one medicine reduces strain on the heart: valsartan blocks signals that narrow blood vessels and retain salt; sacubitril preserves protective hormone signals. It helps prevent hospital stays and death, even if you notice little immediate change. [2] [1]
Why heart-failure guidelines recommend it
PARADIGM-HF compared this medicine with enalapril 10 mg twice daily, an effective heart-failure drug, alongside usual care. Over a median 27 months:
| Entresto | Enalapril |
|---|---|
| 914 / 4,187 (21.8%) | 1,117 / 4,212 (26.5%) |
About 5 fewer people per 100 had cardiovascular death or a first HF hospital stay. Strong guideline recommendation. The trial selected people who tolerated both drugs during a run-in; personal benefit and tolerability vary. [1] [3]
Side effects: compare both groups
| Event | Entresto | Enalapril |
|---|---|---|
| Low blood pressure | (18%) | (12%) |
| High potassium | (12%) | (14%) |
| Angioedema | (0.5%) | (0.2%) |
PARADIGM-HF safety groups: 4,203 vs 4,229 people; median Entresto exposure 24 months. Rounded label percentages; exact counts not given. Run-in selection can understate real-world side effects. [2]
Using it safely
Take it. Usually twice daily; use your prescribed strength. If a dose is missed, take it when remembered unless the next is near; never double up.
36-hour safety gap. Wait at least 36 hours after the last ACE-inhibitor dose (such as lisinopril) before Entresto. The same gap applies when switching back. No extra ARB. Avoid aliskiren if you have diabetes.
Blood tests / urgent help. Arrange blood-pressure, potassium and kidney checks. Review NSAIDs and potassium supplements. For face/throat swelling, stop and seek emergency care. If pregnancy occurs, stop and contact your prescriber promptly. Avoid breastfeeding. Report prior angioedema before starting.
[2]What might I pay out of pocket?
| Payment route | Price, supply and conditions |
|---|---|
| GoodRx cash / coupon | About $39.23 / 30 days: generic 49/51 mg, 60 tablets. Advertised table estimate; local quotes vary. [4] |
| Blueberry Pharmacy cash | $40.59 / 90 days: generic, any strength, 180 tablets; $44.58 with $3.99 nonmember shipping. Equivalent to $14.86/month; requires a 90-day fill. [5] [10] |
| Typical insured benchmark | Employer-plan average copays: $12 / $40 / $71 for tiers 1 / 2 / 3 (2025; plans with 3+ tiers). Not this drug’s copay; check your tier and deductible. [9] |
| Medicare standard-benefit example | Brand Entresto: $73.75 / 30 days = 25% of the $295 negotiated drug price, after the deductible and before the annual cap; dispensing fees excluded. Your plan and generic prices may differ. [6] [7] |
| Medicare Extra Help | If eligible: generally up to $5.10 generic / $12.65 brand per prescription; some pay less. [8] |
US prices checked September 5, 2026. Part D: deductible at most $615; $2,100 yearly out-of-pocket cap across covered Part D drugs, excluding premiums. Cash discounts used instead of Part D do not count toward its deductible/cap. Compare your pharmacy quote before filling.
Entresto’s former manufacturer Co-Pay Program is discontinued.
[12] [8] [11]