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Last updated on April 16th, 2025 at 01:19 pm
Entresto is a prescription medication combining sacubitril and valsartan, used to treat heart failure with reduced ejection fraction by reducing strain on your heart and improving blood flow. Entresto (sacubitril/valsartan) is one of the most significant advances in managing heart failure with reduced ejection fraction (HFrEF). However, it is not suitable for everyone. If you or a loved one is considering Entresto, it’s critical to understand who should not take it and why.
Who Should Not Take Entresto?
While Entresto is a lifesaving medication for many, certain patients should avoid it due to safety concerns. Below are the key groups who should not use Entresto:
1. Patients with a History of Angioedema
If you have ever had angioedema (swelling of the face, lips, throat, or tongue) due to an ACE inhibitor or ARB, you must never take Entresto. This medication increases the risk of severe, life-threatening swelling, especially in Black patients, who have a higher risk of angioedema.
Why?
Entresto contains sacubitril, which inhibits neprilysin. Neprilysin normally breaks down bradykinin, a substance that can cause swelling. Without it, bradykinin builds up, increasing the risk of angioedema.
2. Patients Taking an ACE Inhibitor
Entresto must never be taken with an ACE inhibitor like lisinopril, enalapril, or ramipril. Doing so dramatically increases the risk of angioedema and dangerously low blood pressure (hypotension).
Transitioning from an ACE Inhibitor to Entresto?
- Wait at least 36 hours after stopping your ACE inhibitor before taking Entresto to prevent complications.
3. Patients with Severe Liver Disease
Patients with severe hepatic impairment (Child-Pugh Class C) should not take Entresto. The drug is metabolized in the liver, and severe liver dysfunction can lead to unpredictable drug levels and toxicity.
4. Patients with Low Blood Pressure (Symptomatic Hypotension)
If you have symptomatic low blood pressure (systolic BP <100 mmHg), Entresto is not for you. It can further lower blood pressure, leading to dizziness, fainting, or even shock.
🔹 Who is at higher risk?
- Elderly patients (65+ years)
- Patients on high doses of diuretics
- Those with dehydration or electrolyte imbalances
5. Patients with Severe Kidney Disease
Entresto affects kidney function, and patients with advanced chronic kidney disease (eGFR <30 mL/min/1.73m²) or on dialysis should avoid it. The drug can cause worsening kidney function, high potassium (hyperkalemia), and fluid imbalances.
6. Patients with High Potassium Levels (Hyperkalemia)
Entresto increases potassium levels, which can be dangerous for patients with baseline hyperkalemia (K+ >5.4 mEq/L). Too much potassium can lead to fatal heart rhythm disturbances (arrhythmias).
🔹 Who is at higher risk?
- Patients with chronic kidney disease (CKD)
- Those taking potassium supplements or potassium-sparing diuretics (spironolactone, eplerenone)
- Diabetics, who often have higher potassium levels
7. Pregnant or Breastfeeding Women
Entresto is strictly contraindicated during pregnancy and breastfeeding. It can cause serious birth defects, fetal death, or kidney failure in newborns.
🔹 If you are of childbearing age and taking Entresto:
- Use effective contraception
- Stop immediately if you become pregnant and consult your doctor
8. Patients with Aortic Stenosis or Cardiogenic Shock
- Severe aortic stenosis: Entresto can worsen blood flow obstruction, leading to collapse.
- Cardiogenic shock: If the heart is already failing to pump blood effectively, Entresto can further drop blood pressure, worsening shock.
Key Takeaways
Who should avoid Entresto?
- Anyone with a history of angioedema
- Patients on ACE inhibitors (must stop & wait 36 hours first)
- Severe liver or kidney disease patients
- Those with symptomatic low blood pressure
- Patients with dangerously high potassium levels
- Pregnant or breastfeeding women
- Severe aortic stenosis or cardiogenic shock patients
Entresto is a powerful and effective heart failure medication, but not everyone is a candidate. If you fall into any of these groups, discuss alternative options with your doctor. Never stop or start Entresto without professional guidance, as doing so can have serious health consequences.
If you have questions write to us or post in the comment section below. You can also consult your doctor to determine if Entresto is right for you.
