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Last updated on January 25th, 2025 at 07:14 am
In this comprehensive guide, you will discover what drugs interact with Entresto, how these interactions can affect your health, and what precautions to take. Learn about the common and rare interactions, including those with over-the-counter medications and supplements. If you’re on Entresto, this guide is a must-read for managing your treatment effectively.
When I first learned about Entresto, it was because a family member was prescribed it for heart failure. Understanding how important it was to manage this condition effectively, I took it upon myself to learn everything about the medication, including potential drug interactions. In this comprehensive guide, I’ll share what I’ve discovered about the drugs that interact with Entresto, how these interactions can impact your health, and the precautions you should take. Let’s dive into this critical information, which can help you or your loved ones manage heart failure treatment effectively and safely.
What is Entresto?
Entresto is a prescription medication used to treat heart failure. It combines two drugs: sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker (ARB). Together, these components work to reduce strain on the heart by lowering blood pressure, reducing sodium retention, and decreasing the likelihood of heart failure hospitalizations.
Common Drug Interactions With Entresto
Understanding drug interactions with Entresto is crucial for managing heart failure effectively. Here are some of the common drug interactions that you should be aware of:
1. ACE Inhibitors
Combining Entresto with ACE inhibitors (e.g., lisinopril, enalapril) can lead to an increased risk of angioedema, a potentially life-threatening condition characterized by swelling of the face, lips, tongue, and throat. Due to this risk, it is advised to avoid using Entresto with ACE inhibitors.
2. ARBs
Although Entresto contains valsartan, an ARB, using it in combination with other ARBs (e.g., losartan, irbesartan) can enhance the risk of hyperkalemia (high potassium levels) and renal impairment. It’s important to monitor potassium levels and kidney function regularly if concurrent use is necessary.
3. Aliskiren
Aliskiren is a direct renin inhibitor used to treat hypertension. When taken with Entresto, it can increase the risk of renal impairment, hyperkalemia, and hypotension. This combination is generally not recommended, especially in diabetic patients.
4. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen and naproxen, can reduce the effectiveness of Entresto by causing fluid retention and worsening heart failure. They can also increase the risk of kidney damage when used together with Entresto.
5. Potassium-Sparing Diuretics
Medications like spironolactone and eplerenone, which spare potassium, can lead to hyperkalemia when taken with Entresto. Regular monitoring of blood potassium levels is essential to avoid potentially severe complications.
6. Lithium
The use of lithium with Entresto can increase lithium toxicity due to decreased renal clearance. Symptoms of lithium toxicity include tremors, confusion, and seizures. Monitoring lithium levels closely is advised if these medications must be used together.
7. PDE-5 Inhibitors
PDE-5 inhibitors, such as sildenafil (Viagra), used for erectile dysfunction or pulmonary hypertension, can cause an additive effect with Entresto, leading to an excessive drop in blood pressure. Caution is advised when you are using these medications concurrently.
Less Common Drug Interactions
While the above interactions are more common, other less frequent interactions can still have significant effects:
1. Rifampin
Rifampin, an antibiotic used to treat tuberculosis, can reduce the effectiveness of Entresto by increasing the metabolism of its components. This interaction can diminish the therapeutic benefits of Entresto, necessitating dose adjustments or alternative treatments.
2. Gold Injections
Gold injections used to treat rheumatoid arthritis can interact with Entresto, leading to nutrition reactions characterized by flushing, nausea, vomiting, and hypotension. Patients should be monitored closely for these reactions if concurrent use is required.
3. Dual-Acting Antidepressants
Certain antidepressants that have dual mechanisms of action (e.g., amitriptyline, duloxetine) can enhance the risk of serotonin syndrome when taken with Entresto. Symptoms of serotonin syndrome include agitation, hallucinations, and increased heart rate. Monitoring for signs of serotonin syndrome is crucial.
Over-the-Counter Medications and Supplements
Even over-the-counter (OTC) medications and supplements can interact with Entresto. Here are a few notable examples:
1. Decongestants
Decongestants, such as pseudoephedrine, found in many cold and flu medications, can increase blood pressure and counteract the effects of Entresto. It is best to consult a healthcare provider before using these medications.
2. Herbal Supplements
St. John’s Wort, often used for depression, can decrease the effectiveness of Entresto by inducing liver enzymes that metabolize the drug. Similarly, potassium supplements can exacerbate the risk of hyperkalemia.
3. Antacids
Certain antacids containing magnesium or aluminum can interfere with the absorption of Entresto. To avoid this interaction, it’s recommended to separate the administration of these medications by a few hours.
The Importance of Medication Management
Managing medication interactions is a vital aspect of treating heart failure with Entresto. Here are some key strategies to ensure safe and effective use of this medication:
1. Keep a Comprehensive Medication List
Maintain an up-to-date list of all prescription medications, OTC drugs, and supplements you are taking. Share this list with your healthcare provider to identify potential interactions.
2. Regular Monitoring
Regular monitoring of blood pressure, potassium levels, and kidney function is essential when using Entresto, especially if you are taking other medications that may interact with it.
3. Consult Your Healthcare Provider
Always consult your healthcare provider before starting or stopping any medication, including OTC drugs and supplements. They can help you understand potential interactions and adjust your treatment plan accordingly.
4. Be Aware of Symptoms
Be vigilant about recognizing symptoms of potential drug interactions, such as unusual swelling, changes in blood pressure, or signs of kidney problems. Report these symptoms to your healthcare provider promptly.
What Drugs Should Not be Taken with Entresto?
Certain drugs should be avoided when taking Entresto due to potential interactions that can lead to serious side effects or reduce the effectiveness of the treatment. Here are some drugs and drug classes that should not be taken with Entresto:
1. ACE Inhibitors
Entresto should not be taken with ACE inhibitors (e.g., lisinopril, enalapril, ramipril) due to the risk of angioedema (swelling, particularly of the face and throat). There should be at least a 36-hour gap between stopping an ACE inhibitor and starting Entresto.
2. Aliskiren
Aliskiren, a direct renin inhibitor, should not be used with Entresto, especially in patients with diabetes, due to the risk of increased blood potassium levels, kidney function deterioration, and low blood pressure.
3. ARBs (Angiotensin II Receptor Blockers)
Since Entresto already contains an ARB (valsartan), additional ARBs (e.g., losartan, olmesartan) should not be taken to avoid excessive lowering of blood pressure and increased risk of kidney problems.
4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs (e.g., ibuprofen, naproxen) can reduce the effectiveness of Entresto and increase the risk of kidney damage and hyperkalemia (high potassium levels). Use NSAIDs cautiously and under a doctor’s supervision.
5. Potassium-Sparing Diuretics
Diuretics such as spironolactone, eplerenone, and amiloride can increase the risk of hyperkalemia when taken with Entresto. Regular monitoring of potassium levels is necessary.
6. Lithium
Taking lithium with Entresto can increase the risk of lithium toxicity. Lithium levels should be monitored closely if used together.
7. Certain Antibiotics
Some antibiotics, like trimethoprim-sulfamethoxazole (Bactrim), can increase potassium levels when taken with Entresto, leading to hyperkalemia.
8. CYP450 3A4 Inhibitors
While not a direct contraindication, strong inhibitors of the CYP450 3A4 enzyme (e.g., ketoconazole, itraconazole) can potentially increase the levels of valsartan in the blood, which might necessitate monitoring and dosage adjustment.
9. Other Medications Affecting Potassium Levels
Any other drugs that can raise potassium levels, such as supplements or certain medications used to treat high blood pressure or heart conditions, should be monitored closely.
Always consult your healthcare provider or pharmacist before starting any new medication or supplement while on Entresto. They can provide personalized advice and ensure safe use of all medications.
For a comprehensive details about why these drugs must be avoided when taking Entresto, read “What Drugs Should Not Be Taken with Entresto?“
Entresto and Viagra Together?
Entresto and Viagra can interact because both medications affect blood pressure. Entresto, a heart failure treatment, combines sacubitril and valsartan to relax blood vessels and reduce blood pressure. Viagra, primarily used for erectile dysfunction, also lowers blood pressure by increasing blood flow. When taken together, the combined effect can lead to excessively low blood pressure (hypotension), which may cause dizziness, fainting, or even life-threatening cardiovascular issues. Therefore, it’s essential to consult your healthcare provider before combining these medications to ensure safe and appropriate management of blood pressure and overall cardiovascular health.
Summary
Navigating the complexities of drug interactions with Entresto can be challenging, but it’s a critical aspect of managing heart failure effectively. By understanding the common and less common interactions, as well as the impact of OTC medications and supplements, you can take proactive steps to ensure your treatment is safe and effective. Always keep open communication with your healthcare provider and stay informed about the medications you are taking.
If you found this guide helpful, share it with others who might benefit from this information. Knowledge is the best antidote to the risks associated with medication interactions.
Frequently Asked Questions
1. What should I do if I miss a dose of Entresto?
If you miss a dose of Entresto, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at once.
2. Can I drink alcohol while taking Entresto?
It is advisable to limit alcohol consumption while taking Entresto, as alcohol can lower blood pressure and increase the risk of side effects such as dizziness and fainting.
3. How should I store Entresto?
Store Entresto at room temperature, away from moisture and heat. Keep it out of reach of children and pets.
4. What are the signs of an allergic reaction to Entresto?
Signs of an allergic reaction to Entresto include rash, itching, swelling of the face, lips, or throat, and difficulty breathing. Seek immediate medical attention if you experience these symptoms.
5. Can I take Entresto if I’m pregnant or breastfeeding?
Entresto is not recommended for use during pregnancy due to the risk of harm to the unborn baby. Consult your healthcare provider if you are breastfeeding, as it is unknown whether Entresto passes into breast milk.
By staying informed and vigilant, you can manage your heart failure treatment with Entresto safely and effectively. Always prioritize open communication with your healthcare provider and take an active role in your healthcare journey.
6. Can I Take Ibuprofen With Entresto?
It is not advisale to take ibuprofen with Entresto (sacubitril/valsartan) without consulting your healthcare provider. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can reduce the effectiveness of Entresto and potentially increase your risk of kidney problems, especially in individuals with pre-existing kidney issues. Both medications can also raise your blood potassium levels, leading to hyperkalemia, which can be dangerous. Always consult your healthcare provider before combining these medications to avoid potential interactions and side effects.
7. Can You Take Antacids with Entresto?
You can take antacids with Entresto (sacubitril/valsartan). However do so with caution. Antacids can affect the absorption of some medications, so it’s best to take entresto and antacids at different times. For example, you might take Entresto and then wait a couple of hours before taking an antacid. Remember to always consult your doctor or pharmacist before combining medications to ensure it’s safe for your specific situation.
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