Entresto to lisinopril conversion is not a simple milligram-for-milligram swap. You need a 36-hour washout when switching between Entresto and any ACE inhibitor such as lisinopril, because taking them too close together raises the risk of angioedema and other serious side effects.
What the switch means
Entresto contains sacubitril and valsartan, while lisinopril is an ACE inhibitor, so they work differently and are not directly equivalent dose-for-dose. Entresto is used for heart failure, and lisinopril is used for heart failure, high blood pressure, and after a heart attack.
If you are moving from Entresto to lisinopril, your clinician usually stops Entresto first, waits 36 hours, and then starts lisinopril at a dose chosen for your condition, blood pressure, kidney function, and prior ACE inhibitor exposure.hospitalhandbook.
The key safety rule
Do not take lisinopril until at least 36 hours after your last Entresto dose. Entresto’s prescribing guidance also says it must not be used at the same time as an ACE inhibitor.
That gap matters because both medicines affect the same hormonal pathway that regulates blood pressure and fluid balance, and overlap increases the chance of dangerous swelling and low blood pressure.goodrx+1
How lisinopril is usually started
Lisinopril does not have a direct “Entresto conversion” table, so the starting dose is based on the reason for treatment rather than on Entresto strength. For heart failure, a common starting dose is 5 mg daily, while hypertension often starts at 10 mg daily.
A prescriber may start lower if you are older, volume-depleted, already on diuretics, have kidney disease, or tend to run low blood pressure.hospitalhandbook.ucsf+1
What to monitor after the switch
After the switch, watch for dizziness, fainting, swelling of the face or lips, persistent cough, reduced urine output, or unusual weakness. Lisinopril can cause cough and low blood pressure, while Entresto and ACE inhibitors can both affect kidney function and potassium levels.
Your clinician may check blood pressure, creatinine, and potassium shortly after the change and again after dose adjustments.hospitalhandbook.ucsf+1
Example transition
If you took your last Entresto dose on Monday at 8 a.m., you should not start lisinopril until Wednesday at 8 p.m. or later. The exact lisinopril dose would then depend on your heart failure or blood pressure plan, not on the Entresto tablet strength.hospitalhandbook.ucsf+1
Practical patient guidance
- Do not overlap the two medicines.
- Keep the 36-hour washout.
- Ask whether your starting lisinopril dose should be 5 mg or 10 mg based on your condition.
- Get labs and blood pressure checks soon after the change.