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Last updated on March 4th, 2025 at 09:07 am
When managing heart failure or hypertension, patients and caregivers often encounter multiple medications designed to improve heart function and overall health. However, not all drugs can be safely combined. One common question arises: “Can you take Entresto with lisinopril?” The short answer is no, and here, I will explain why.
Entresto and Lisinopril
What Is Entresto?
Entresto is a prescription medication that combines two active ingredients:
- Sacubitril: A neprilysin inhibitor that helps relax blood vessels, reduce fluid retention, and decrease strain on the heart.
- Valsartan: An angiotensin receptor blocker (ARB) that lowers blood pressure and improves blood flow.
Entresto is primarily used to treat heart failure with reduced ejection fraction (HFrEF) and is known to improve survival and reduce hospitalizations in eligible patients.
What Is Lisinopril?
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat conditions like:
- Hypertension (high blood pressure)
- Heart failure
- Post-heart attack recovery
It works by relaxing blood vessels and reducing the workload on the heart.
Why Can’t You Take Entresto and Lisinopril Together?
Taking Entresto and lisinopril simultaneously is strictly contraindicated due to severe and potentially life-threatening risks. Below are the key reasons:
1. Risk of Angioedema
Angioedema is a serious allergic reaction that causes tissue swelling, particularly around the face, throat, and airways. Both Entresto and lisinopril affect the renin-angiotensin-aldosterone system (RAAS), increasing the likelihood of this condition. The risk is compounded when taken together, potentially resulting in a medical emergency.
2. Hyperkalemia (High Potassium Levels)
Both medications influence potassium levels in the blood. Combining them can lead to hyperkalemia, a condition where potassium levels rise dangerously high. Elevated potassium can cause:
- Irregular heart rhythms (arrhythmias)
- Weakness
- Cardiac arrest in severe cases
3. Severe Hypotension (Low Blood Pressure)
Entresto and lisinopril both lower blood pressure. Using them together can cause excessive drops in blood pressure, leading to:
- Dizziness
- Fainting
- Shock in extreme cases
4. Increased Risk of Kidney Damage
Both drugs will impact your kidney function. When used together, the risk of renal impairment or kidney failure is significantly higher, especially in patients with pre-existing kidney conditions.
Clinical Guidelines and Warnings
FDA Recommendations
The U.S. Food and Drug Administration (FDA) explicitly warns against the concurrent use of Entresto and any ACE inhibitor, including lisinopril. This precaution is included in Entresto’s prescribing information.
Mandatory Washout Period
If you are transitioning from an ACE inhibitor like lisinopril to Entresto, you must undergo a 36-hour washout period. This gap allows the body to clear the ACE inhibitor, reducing the risk of angioedema and other complications.
Standard of Care
Entresto is often prescribed as a replacement for ACE inhibitors or ARBs in patients with heart failure. However, it is never used alongside these medications.
Who Might Search for This Information?
This question typically comes from individuals managing cardiovascular conditions such as:
- Heart failure patients: Considering switching medications for better symptom control.
- Caregivers: Seeking to ensure medication safety for loved ones.
- Healthcare students: Learning about contraindications in pharmacology.
- General patients: Clarifying instructions from their healthcare providers.
Exploring Safer Alternatives
If you’re taking lisinopril and are considering Entresto, you must consult your doctor. Below are some safe Entresto alternatives and guidelines:
1. Switching from Lisinopril to Entresto
(You can learn in depth how to switch from Lisinopril to Entresto)
- Follow the 36-hour washout period before starting Entresto.
- Monitor blood pressure, kidney function, and potassium levels closely during the transition.
2. Continuing Lisinopril Alone
- If Entresto is not an option, lisinopril can still effectively manage heart failure and hypertension in many cases.
- Regular follow-ups are necessary to ensure the medication remains effective.
3. Other Medication Options
- ARB Medications: Alternatives like valsartan or losartan may be used instead of ACE inhibitors.
- Beta-Blockers: Drugs like carvedilol or metoprolol may be added to your regimen to improve heart function.
Frequent Concerns
1. Why Can’t Entresto Be Taken with an ACE Inhibitor?
Both medications affect the same system (RAAS), increasing the risk of severe side effects like angioedema, hyperkalemia, and kidney damage.
2. What Happens If You Accidentally Take Entresto and Lisinopril Together?
Contact your doctor or seek emergency medical attention immediately. Watch for symptoms like swelling (angioedema), dizziness, or irregular heartbeat.
3. How Long Should You Wait Between Stopping Lisinopril and Starting Entresto?
A 36-hour washout period is required to reduce the risk of angioedema and other complications.
4. Can Entresto Replace Lisinopril?
Entresto is often prescribed as a replacement for ACE inhibitors like lisinopril in heart failure patients. However, this decision should be made by your doctor.
5. What Are Signs of Angioedema?
Signs include swelling of the face, lips, tongue, or throat, difficulty breathing, and hives. Seek emergency care immediately if these occur.
The combination of Entresto and lisinopril is not safe due to the high risk of severe side effects, including angioedema, hyperkalemia, and kidney damage. If you’re considering switching from lisinopril to Entresto, ensure you follow the recommended 36-hour washout period and consult your healthcare provider for personalized advice. Can you switch from Entresto to Lisinopril?… Learn more from the link.
Your safety depends on careful medication management—always prioritize professional guidance when adjusting your treatment plan.
