Entresto is available in three adult tablet dosage strengths: 24/26 mg, 49/51 mg, and 97/103 mg, taken twice daily. The usual approach is to start at 24/26 mg twice daily in many patients and increase every 2 to 4 weeks as tolerated until the target dose is reached.
Dosage strengths
The three standard ENTRESTO tablet strengths are listed by the manufacturer as:
- 24/26 mg twice daily.
- 49/51 mg twice daily.
- 97/103 mg twice daily.
These strengths are the same medication components expressed as sacubitril/valsartan. The numbers are not interchangeable with simple single-ingredient dosing, so the exact strength matters.
How dosing is usually selected
According to the manufacturer, the starting dose depends on the patient’s prior treatment and clinical status. In many adults, especially those not on a high ACE inhibitor or ARB dose, treatment begins at 24/26 mg twice daily and is then doubled every 2 to 4 weeks if tolerated.
For patients already on higher doses of ACE inhibitors or ARBs, clinicians may choose a higher starting dose. The goal is generally to titrate up to 97/103 mg twice daily as tolerated.
Switching precautions
If a patient is switching from an ACE inhibitor, a 36-hour washout period is required before starting Entresto. The manufacturer also notes that a washout is not required when switching from an ARB to Entresto.
Entresto is contraindicated with concomitant ACE inhibitor use, so it should not be taken together with that drug class.
Special populations
For severe renal impairment or moderate hepatic impairment, the manufacturer still lists the available strengths but recommends careful prescribing and typically starts at the lower dose, 24/26 mg twice daily, as tolerated. Mild renal impairment and mild hepatic impairment do not require a starting dose adjustment according to the same source.
Summary
Entresto dosage strengths: what patients and clinicians should know!
Entresto is a prescription heart failure medicine with three adult tablet strengths: 24/26 mg, 49/51 mg, and 97/103 mg, all taken twice daily. The dose is usually started low and increased gradually based on tolerance, with 97/103 mg twice daily serving as the common target dose.
Dose selection depends on the patient’s prior ACE inhibitor or ARB use, kidney and liver function, and how well they tolerate treatment. A 36-hour washout is required when switching from an ACE inhibitor to Entresto, but not when switching from an ARB.
A key safety point is that Entresto should not be used together with an ACE inhibitor. Because the strengths are fixed combinations, it is important not to substitute them casually or assume they are equivalent to one another.