Entresto should not be taken with ACE inhibitors, aliskiren in certain patients, or another ARB such as valsartan, because these combinations raise the risk of serious harm, including angioedema, low blood pressure, kidney problems, and high potassium levels. You should also avoid or use extreme caution with potassium-raising medicines, NSAIDs, and lithium because they can worsen Entresto’s safety risks.
Drugs you should not combine with Entresto
The most important medicines to avoid are:
- ACE inhibitors such as lisinopril, enalapril, captopril, and ramipril. Entresto must not be used at the same time, and you need a 36-hour washout when switching between them.
- Aliskiren in people with diabetes, and also in people with renal impairment when the eGFR is below 60 mL/min/1.73 m2. This combination is contraindicated or not recommended because it increases the risk of hypotension, hyperkalemia, and kidney injury.
- Other ARBs such as losartan, valsartan, candesartan, irbesartan, and olmesartan. Entresto already contains valsartan, so taking another ARB duplicates the same drug class.
Medicines that need caution
You should be careful with these because they can make Entresto’s side effects more likely:
- Potassium-sparing diuretics such as spironolactone, eplerenone, amiloride, and triamterene, because they can raise potassium further.
- Potassium supplements and salt substitutes containing potassium, which can also push potassium to unsafe levels.
- NSAIDs such as ibuprofen, naproxen, diclofenac, and celecoxib, because they can worsen kidney function, especially if you are older, dehydrated, on diuretics, or already have kidney disease.
- Lithium, because Entresto can increase lithium levels and raise the risk of toxicity.
Other interactions to know
Some medicines are not absolutely forbidden, but they still deserve attention. PDE5 inhibitors such as sildenafil can lower blood pressure more when used with Entresto, so your prescriber may want to monitor you closely . Statins may also have increased exposure with Entresto, so your clinician may watch for side effects if you take them together .
Pregnancy and breastfeeding
You should not take Entresto during the second and third trimesters of pregnancy, and it is also not recommended in breastfeeding because of the potential risk to the baby. If you become pregnant while taking it, treatment should be stopped promptly and replaced with a safer option under medical guidance.
Practical takeaway
Before starting Entresto, you should tell your clinician about every prescription drug, over-the-counter pain reliever, supplement, and herbal product you use. The safest approach is to avoid ACE inhibitors, avoid aliskiren in the listed groups, avoid other ARBs, and check before using potassium products, NSAIDs, or lithium.