Entresto’s Dosage: What to Know
This drug has a boxed warning, the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
Taking Entresto during pregnancy could result in injury or death to a developing fetus. Due to this risk, doctors typically will not prescribe Entresto during pregnancy. And they will discontinue Entresto treatment as soon as possible if pregnancy occurs.
Entresto is a brand-name prescription medication that contains the active drugs sacubitril and valsartan. Sacubitril belongs to a class of drugs called neprilysin inhibitors and valsartan is an angiotensin II receptor blocker. Entresto is not available in a generic form.
This medication has been approved by the Food and Drug Administration (FDA) to:
- reduce the risk of death and hospitalization in adults with certain types of chronic (long-term) heart failure
- treat certain types of heart failure that cause symptoms in children ages 1 year and older
In this article, you’ll find additional information about Entresto’s dosage and details on how to take the drug. For a comprehensive overview of Entresto, view this article.
Finding a healthcare professional
If you’re interested in taking Entresto, search here to find a doctor who might prescribe it.
This article describes typical recommended dosages for Entresto. These dosages are provided by the drug’s manufacturer.
Always follow the dosage of Entresto that your doctor prescribes.
Commonly recommended dosages for Entresto are shown below. However, your doctor will prescribe the Entresto dosage that’s right for you.
Entresto’s form and strengths
Entresto is available as an oral tablet.
It comes in the following strengths:
- 24 milligrams (mg) sacubitril/26 mg valsartan
- 49 mg sacubitril/51 mg valsartan
- 97 mg sacubitril/103 mg valsartan
Pharmacists can prepare an oral suspension for people who aren’t able to swallow tablets. (An oral suspension is a type of liquid mixture.) The suspension contains 1.96 mg of sacubitril and 2.04 mg of valsartan per milliliter (mL) of liquid, for a final strength of 4 mg/mL.
Typical recommended dosage
Usually, doctors will prescribe a low dosage of Entresto at the start of treatment. Then, they’ll adjust the dosage over time, if needed. These adjustments typically occur every 2 to 4 weeks. Ultimately, your doctor will prescribe the smallest dosage of Entresto that gives the desired effect.
Below is an overview of Entresto’s recommended dosage for heart failure in adults. Your doctor will prescribe the dosage of Entresto that’s right for your condition.
- Starting dosage: 49 mg sacubitril/51 mg valsartan two times per day
- Maintenance dosage: 97 mg sacubitril/103 mg valsartan two times per day
- Maximum dosage: 97 mg sacubitril/103 mg valsartan two times per day
The dosage of Entresto for children ages 1 year and older with heart failure is based on the child’s body weight in kilograms (kg). (One kg equals about 2.2 pounds [lb].)
The doses shown in the following table are given two times per day.
Doctors will prescribe a starting dose, followed by a second increased dose and a final maintenance dose. These doses are shown in the table below.
|Body weight in kg||Approximate body weight in lb||Starting dose||Second dose||Final maintenance dose|
|less than 40 kg||less than 88 lb||1.6 mg active drug in oral suspension per kg of body weight||2.3 mg active drug in oral suspension per kg of body weight||3.1 mg active drug in oral suspension per kg of body weight|
|40 kg to 49.9 kg||88 lb to 109 lb||24 mg sacubitril/26 mg valsartan||49 mg sacubitril/51 mg valsartan||72 mg sacubitril/78 mg valsartan|
|50 kg or more||110 lb or more||49 mg sacubitril/51 mg valsartan||72 mg sacubitril/78 mg valsartan||97 mg sacubitril/103 mg valsartan|
For example, assume a child who weighs 30 kg (about 66 lb) is prescribed Entresto oral suspension. The child’s starting dose will be 48 mg of active drug in the oral suspension. The suspension contains 4 mg/mL, so the child would take 12 mL two times per day.
Alternatively, assume a child who weighs 45 kg (about 99 lb) is prescribed Entresto oral tablets. The child’s starting dose will be one 24 mg sacubitril/26 mg valsartan tablet, taken twice per day. The final dose of 72 mg sacubitril/78 mg valsartan will be made up of three 24 mg sacubitril/26 mg valsartan tablets, taken twice per day.
Length of treatment
Doctors typically prescribe Entresto as a long-term treatment. You’ll likely take it long term if you and your doctor feel it’s safe and effective for your condition.
Below are some common questions related to Entresto’s dosage.
Does Entresto have a dosing chart?
Yes, an Entresto dosing guide, including a recommended dosing chart for children, is shown in the section directly above. The dosing chart for children is based on a child’s body weight in kilograms (kg). (One kg equals about 2.2 pounds [lb].)
To view this information, see the “Entresto: Dosage” section above. Talk with your doctor or pharmacist if you have additional questions about dosages for this drug.
Is there a recommended highest or lowest dose of Entresto?
The lowest dosage of Entresto recommended for adults is 24 milligrams (mg) sacubitril/26 mg valsartan twice per day. The maximum recommended dosage is 97 mg sacubitril/103 mg valsartan twice per day.
These recommendations differ for children prescribed the drug. For details, see the “Entresto: Dosage” section above.
If you’d like to know more about possible doses of Entresto, talk with your doctor or pharmacist.
What are Entresto’s dose sizes?
The available doses of Entresto oral tablets are as follows:
- 24 milligrams (mg) sacubitril/26 mg valsartan
- 49 mg sacubitril/51 mg valsartan
- 97 mg sacubitril/103 mg valsartan
It’s not commercially available, but an oral suspension of Entresto can be made by pharmacists. (An oral suspension is a type of liquid mixture.)
This suspension may be made for people who aren’t able to swallow tablets. The oral suspension contains 1.96 mg of sacubitril/2.04 mg of valsartan per milliliter (mL) of liquid. This gives a final strength of 4 mg/mL.
If you’d like to know more about available strengths of Entresto, ask your doctor or pharmacist.
If I have renal (kidney) problems, does Entresto require certain renal dosing adjustments?
Yes, there is a renal dosing adjustment for Entresto in both adults and children with severe kidney problems. (Kidney problems, such as renal failure, may also be referred to as renal impairment.)
In this case, doctors usually prescribe a starting dosage of Entresto that’s half of the typical recommended starting dose. An adjustment is not needed for people with mild or moderate renal impairment.
Doctors determine how severe renal impairment is by using an estimated glomerular filtration rate (GFR), or eGFR. The results of a simple lab test let your doctor calculate your eGFR. The results show how well your kidneys are working to filter your blood.
To learn more about taking Entresto if you have kidney problems, talk with your doctor or pharmacist.
Your doctor will consider several factors when prescribing the dosage for Entresto. These factors include:
- your age
- the severity of your condition
- other medical conditions you have
Recommended adjustments in dosage
Your doctor may reduce your starting dose of Entresto if:
- You have moderate liver problems. However, Entresto is not recommended for people with severe liver problems.
- You have never taken an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), or have taken only low doses of these drugs. (ACE inhibitors and ARBs are classes of drugs used to manage high blood pressure.)
- You have severe kidney problems. To learn more about this, see the “Entresto: Common questions about dosage” section above.
Entresto comes as an oral tablet. You’ll take it by mouth.
If you’re not able to swallow tablets, your pharmacist can make an oral suspension of Entresto using the tablets. (An oral suspension is a type of liquid mixture.) You’ll take this form by mouth.
If you have difficulty swallowing tablets, view this article. It provides suggestions on how to take this form of medication. Also, talk with your doctor or pharmacist about taking your medication.
If you find it challenging to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies provide medication labels with large print or braille. They may also offer labels containing a scannable code that your smartphone can convert from text to speech. If your pharmacy doesn’t provide these choices, your doctor or pharmacist may be able to recommend a pharmacy that does.
If it’s difficult for you to open medication bottles, ask your pharmacist if they can dispense Entresto in an easy-open container. They also may recommend ways to help make it easier to open the bottles.
If you miss a dose of Entresto, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose. Take your next dose at the regular time.
If you’re not sure when to take or skip a missed dose, ask your doctor or pharmacist.
View these medication reminder options to help avoid missing doses. You could also set an alarm or download a reminder app on your phone.
If you take more than the recommended dosage of Entresto, serious effects can occur. Do not take more Entresto than your doctor prescribes.
Symptoms of overdose
An overdose of Entresto could cause excessively low blood pressure. Symptoms of blood pressure that’s too low include:
- blurred vision or vision with fading around the edges
- clammy skin
- dizziness or lightheadedness
- problems concentrating
What to do in case of overdose
Call your doctor if you think you’ve taken too much of this drug. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or a local emergency number. Or go to the nearest emergency room right away.
Talk with your doctor or pharmacist for additional information about Entresto’s dosage. Keep in mind that the dosages presented in this article are typical dosages provided by the drug’s manufacturer. Your doctor will recommend the dosage of Entresto that’s right for you and your condition. Always follow the dosage that your doctor prescribes for you.
As with any medications you’re taking, do not change your Entresto dosage without a recommendation from your doctor.
In addition to discussing Entresto with your doctor, you may find the following articles helpful in learning more.
- Overview of Entresto. For comprehensive details on Entresto, see this article.
- Drug comparisons. To learn how Entresto compares with losartan, read this article.
- Information on side effects. If you’d like to know about possible side effects of Entresto, view this article.
- Details about heart failure. To learn more about heart failure, which Entresto is used to treat, see this article.
Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.