What is Entresto Washout?
Entresto Washout refers to the minimum 36‑hour gap required when switching from an ACE inhibitor to Entresto, aimed at minimizing angioedema risk.
Entresto, a combination of sacubitril and valsartan, must not be started until 36 hours after the last dose of an ACE inhibitor (e.g., lisinopril, enalapril). This “washout period” helps prevent angioedema, a serious, potentially life-threatening swelling reaction that’s more likely when the two drug classes overlap.
Clinical guidelines—including the FDA label, Novartis prescribing info, and ACC/AHA guidance—consistently recommend a 36‑hour washout when transitioning between an ACE inhibitor and Entresto. In contrast, switching from an ARB (like valsartan) requires no washout; one can start Entresto at the next scheduled dose (within 12–24 hours).
Some regional protocols (e.g., NHS Scotland) conservatively advise up to a 48‑hour interval, but the majority of evidence and regulatory sources support 36 hours.
Why the 36‑Hour Washout Matters
- Prevents angioedema: Overlapping ACE inhibition with neprilysin blockade increases the risk of dangerous swelling in the face, tongue, or airway.
- Ensures safety and efficacy: Clears residual ACE inhibitor activity, allowing Entresto to work effectively without increased adverse effects.
Practical Tips
| Step | Action |
|---|---|
| 1 | Stop ACE inhibitor (e.g., lisinopril) |
| 2 | Wait 36 hours passively—no new RAS inhibitor |
| 3 | Start Entresto at appropriate dose |
Patients should be closely monitored during this transition—especially for blood pressure, kidney function, and potassium levels—as per clinical protocol.