What Drugs Should Not Be Taken with Entresto?

If you’ve recently been prescribed Entresto or are considering it as a treatment option for heart failure, one of the most critical facts to understand is how this medication interacts with other drugs. Knowing what drugs should not be taken with Entresto can help you prevent serious side effects and ensure that you get the most benefit from your treatment. This guide provides a detailed, easy-to-understand explanation of potential drug interactions and how to manage them safely.

Entresto

Entresto (sacubitril/valsartan) is a prescription medication used to treat heart failure. It combines two components:

• Sacubitril, which helps relax blood vessels and reduce strain on the heart by inhibiting an enzyme called neprilysin.
• Valsartan, an angiotensin receptor blocker (ARB) that lowers blood pressure and helps protect the heart and kidneys.

While Entresto is highly effective in managing heart failure, it has specific interactions with other medications that can lead to potentially harmful effects. Let’s explore these interactions in detail.

Drugs You Should Avoid While Taking Entresto

1. ACE Inhibitors (e.g., Lisinopril, Enalapril)

Why avoid?

• Combining Entresto with ACE inhibitors increases the risk of angioedema (severe swelling, particularly in the face and throat) and dangerously high potassium levels (hyperkalemia).
• It can also lead to severe drops in blood pressure (hypotension) and kidney dysfunction.

Action to take:

• Stop ACE inhibitors at least 36 hours before starting Entresto. This “washout period” is essential to reduce the risk of severe side effects.

2. ARBs (e.g., Losartan, Valsartan)

Why avoid?

• Entresto already contains valsartan, an ARB. Taking additional ARBs can cause excessive effects on the renin-angiotensin system, leading to hyperkalemia, kidney damage, and dangerously low blood pressure.

Action to take:

• Avoid using Entresto alongside any ARB medication.

3. Potassium-Sparing Diuretics (e.g., Spironolactone, Amiloride)

Why avoid?

• These medications can increase potassium levels, and combining them with Entresto may result in severe hyperkalemia. Symptoms of high potassium include muscle weakness, irregular heartbeats, and fatigue.

Action to take:

• If potassium-sparing diuretics are necessary, close monitoring of potassium levels is required.

4. NSAIDs (e.g., Ibuprofen, Naproxen)

Why avoid?

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce kidney function and diminish the blood pressure-lowering effects of Entresto. This combination increases the risk of kidney damage, particularly in people with pre-existing kidney issues.

Action to take:

• Avoid chronic use of NSAIDs. Consult your doctor for alternatives like acetaminophen for pain relief.

5. Aliskiren (a Direct Renin Inhibitor)

Why avoid?

• Aliskiren and Entresto both act on the renin-angiotensin system. Using them together can lead to kidney dysfunction, hyperkalemia, and severe drops in blood pressure.
• The risk is particularly high for people with diabetes or chronic kidney disease.

Action to take:

• Avoid using aliskiren with Entresto if you have diabetes or kidney impairment.

6. Lithium

Why avoid?

• Entresto can increase lithium levels in the blood, raising the risk of lithium toxicity. Symptoms include confusion, tremors, nausea, and kidney damage.

Action to take:

• If lithium is necessary, your doctor will closely monitor its levels in your blood.

7. Loop Diuretics (e.g., Furosemide)

Why avoid?

• Entresto may alter the effectiveness of loop diuretics, potentially impacting fluid balance and electrolyte levels.

Action to take:

• Adjust loop diuretic doses as needed under medical supervision.

8. Medications Causing Hypotension (e.g., Sildenafil, Tadalafil)

Why avoid?

• Combining Entresto with medications that lower blood pressure, such as PDE-5 inhibitors used for erectile dysfunction, can cause excessive drops in blood pressure, leading to dizziness, fainting, or even shock.

Action to take:

• Use these medications cautiously and only under your doctor’s guidance.

Symptoms of Drug Interactions to Watch For

While taking Entresto, you should be vigilant for signs of potential drug interactions, including:

• Severe dizziness or fainting
• Unusual swelling (especially in the face, lips, or throat)
• Irregular heartbeat
• Muscle weakness or cramps
• Significant changes in urination (too much or too little)
• Fatigue or confusion

If you experience any of these symptoms, seek medical attention immediately.

Managing Drug Interactions with Entresto

To reduce the risk of harmful interactions, follow these tips:

1. Provide a Complete Medication List

Share a full list of all medications, supplements, and over-the-counter drugs you’re taking with your doctor or pharmacist.

2. Monitor Potassium and Kidney Function

Routine blood tests can help detect early signs of hyperkalemia or kidney impairment. Regular monitoring is especially important if you’re taking diuretics or other medications that affect potassium levels.

3. Avoid Self-Medicating

Do not start or stop any medication without consulting your healthcare provider. Even common over-the-counter drugs like ibuprofen can have serious interactions with Entresto.

4. Understand the Washout Period

If you’re switching from an ACE inhibitor to Entresto, the 36-hour washout period is crucial to prevent severe side effects.

5. Stay Hydrated

Dehydration can worsen the effects of Entresto, particularly if you’re taking diuretics. Drink plenty of fluids unless otherwise advised by your doctor.

What people are Asking

1. Can I take Tylenol with Entresto?

Acetaminophen (Tylenol) is generally safe to use with Entresto and does not pose the same risks as NSAIDs like ibuprofen.

2. What should I do if I accidentally take an ACE inhibitor with Entresto?

Stop taking the ACE inhibitor immediately and contact your healthcare provider. Monitor for symptoms like swelling, dizziness, or difficulty breathing.

3. How often should I get my potassium levels checked while on Entresto?

Your doctor will recommend a schedule, but potassium levels are typically checked every few weeks after starting Entresto or after dose adjustments.

4. Is it safe to take herbal supplements with Entresto?

Some herbal supplements, like potassium-containing products or those affecting blood pressure, may interact with Entresto. Always discuss supplements with your healthcare provider.

Understanding what drugs should not be taken with Entresto is essential for your safety and the effectiveness of your treatment. Avoiding certain medications like ACE inhibitors, ARBs, NSAIDs, and potassium-sparing diuretics can help prevent serious side effects such as kidney damage, hyperkalemia, and hypotension. Always consult your doctor or pharmacist before starting, stopping, or changing any medication. By staying informed and vigilant, you can manage your heart failure effectively and safely with Entresto.