Entresto alternatives: What can you take instead of Entresto?

In this article:

• Who shouldn’t take Entresto?
• What can I take in place of Entresto?
• Top 5 Entresto alternatives
• Compare Entresto alternatives
• Natural alternatives to Entresto
• How to switch to an Entresto alternative

In this article

• Who shouldn’t take Entresto?
• What can I take in place of Entresto?
• Top 5 Entresto alternatives
• Compare Entresto alternatives
• Natural alternatives to Entresto
• How to switch to an Entresto alternative

Entresto (sacubitril/valsartan) is a first-of-its-kind prescription medication made by Novartis Pharmaceuticals. It’s used to lower the risk of cardiovascular death and hospitalization related to heart failure in people with chronic heart failure. Entresto is a combination tablet of two different medications: an angiotensin II receptor blocker (valsartan) and a neprilysin inhibitor (sacubitril). These two medications work together as an angiotensin receptor-neprilysin inhibitor (ARNI) to widen blood vessels, leading to increased blood flow and reduced blood pressure. (High blood pressure and reduced blood flow both contribute to congestive heart failure symptoms and worsening of the condition.) Additionally, these two medications can decrease the amount of sodium and fluid in the body to prevent symptoms of swelling, weight gain, and shortness of breath.

Who shouldn’t take Entresto?

While an effective treatment for some people, Entresto may not be the best option for everyone with chronic heart failure. People who should avoid or switch their Entresto medication to a different heart failure medication include:

• People who are pregnant or breastfeeding
• Those who experienced an allergic reaction to Entresto or any ingredient in the medicine
• Anyone with a history of angioedema related to previous ACE inhibitor or ARB therapy
• Anyone also taking ACE inhibitors or ARB medications
• Anyone with diabetes who is also taking the medication aliskiren

Additionally, people taking lithium, non-steroidal anti-inflammatory drugs (NSAIDs), or potassium-sparing diuretics (such as spironolactone, triamterene, or amiloride) are at risk for dangerous drug interactions with Entresto. While these combinations are not strictly contraindicated, a different heart failure medication may be safer in some cases. 

Entresto is available as both a brand-name medication and generic, but may still be an expensive treatment option even with insurance or your Medicare prescription plan. Some people may consider alternative medications due to cost. Free coupons for Entresto and its generic are available from SingleCare.

RELATED: Entresto side effects

What can I take in place of Entresto?

There are many types of medications used in people with heart failure, including those that help improve survival and those that help with symptoms. People will often take more than one medication to help treat heart failure. 

Medications used to help manage symptoms include diuretics (water pills) and digoxin. Entresto helps improve survival in people with heart failure. Since Entresto is the only medication in the angiotensin receptor-neprilysin inhibitor (ARNI) class, there are no available alternatives within the same drug class. However, alternative medications that have shown improved survival in heart failure include some of the ACE inhibitors, ARBs, beta blockers, and SGLT2 inhibitors.

Top 5 Entresto alternatives

1. Enalapril

Enalapril is an angiotensin-converting enzyme inhibitor (ACE inhibitor), also known by the brand name Vasotec. It is FDA approved for the following uses:

• Hypertension (high blood pressure)
• Heart failure
• Asymptomatic left ventricular dysfunction

Specifically in terms of heart failure treatment, enalapril is typically used in combination with diuretics and digoxin. It helps improve symptoms, increase survival, and decrease hospitalizations. 

In people with heart failure, the most common side effects include hypotension (low blood pressure) and dizziness. ACE inhibitors are also frequently associated with a dry cough, which may be bothersome and cause some people to seek an alternative. Individuals who are pregnant or breastfeeding should not take ACE inhibitors such as enalapril. 

2. Valsartan

Valsartan, generic for Diovan, is classified as an ARB (angiotensin receptor blocker). It is FDA approved for the following indications: 

• To reduce the risk of hospitalization for heart failure in adults with heart failure (NYHA class II-IV, which includes mild to severe heart failure) 
• Hypertension
• To reduce cardiovascular death in stable patients with left ventricular failure or left ventricular dysfunction after a heart attack  

Valsartan is one of two active ingredients in Entresto and is available individually as a tablet. In people with heart failure, the most common side effects of valsartan include dizziness, low blood pressure, back and joint pain, fatigue, diarrhea, and high potassium levels in the blood. Like enalapril, valsartan should not be used if you are pregnant or breastfeeding. 

RELATED: Valsartan side effects

3. Carvedilol

Carvedilol is classified as an alpha and beta blocker, also known by the brand name Coreg. Carvedilol is FDA approved to treat:

• Mild to severe chronic heart failure
• Left ventricular dysfunction after a heart attack in stable patients
• Hypertension 

Common side effects of carvedilol include dizziness, weakness, fatigue, low blood pressure, diarrhea, high blood sugar, weight gain, and slowed heart rate. This drug should be avoided in certain patients, such as those with asthma, sick sinus syndrome, severe bradycardia (severely slowed heart rate), and certain other conditions.

RELATED: What’s the best beta blocker for heart failure?

4. Jardiance (empagliflozin)

Jardiance is part of a group of drugs called SGLT2 inhibitors and contains the active ingredient empagliflozin. It is a brand-name drug, with no generic yet available.

Jardiance has several FDA approvals:

• In patients with heart failure, Jardiance reduces the risk of cardiovascular death and heart failure-related hospitalizations.
• In patients with chronic kidney disease, Jardiance can prevent worsening of kidney disease, cardiovascular death, and hospitalization.
• In patients with both Type 2 diabetes and heart disease, Jardiance reduces the risk of cardiovascular death.
• In patients with Type 2 diabetes, Jardiance helps control blood sugar levels.

The most common side effects of Jardiance include urinary tract infections (UTIs) and yeast infections. 

In 2022, the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America (HFSA) published updated guidelines for heart failure treatment. SGLT2 inhibitors, which are a relatively newer class of medications, are now strongly recommended for many patients with heart failure based on evidence showing they reduce hospitalizations and improve survival.

RELATED: Heart disease statistics

5. Farxiga (dapagliflozin)

Like Jardiance, Farxiga is an SGLT2 inhibitor. Farxiga, which contains the active ingredient dapagliflozin, is available in both brand and generic forms. Its FDA approvals are very similar to Jardiance and include:

• In heart failure patients, Farxiga reduces the risk of cardiovascular death, heart failure hospitalizations, and urgent heart failure medical visits.
• In chronic kidney disease patients, Farxiga can prevent worsening of kidney disease, cardiovascular death, and heart failure hospitalization. 
• Farxiga reduces the risk of heart failure hospitalization in people with Type 2 diabetes and heart disease, or those with multiple cardiovascular risk factors.
• Farxiga helps control blood sugar levels in people with Type 2 diabetes.

The most common side effects of Farxiga include:

• Vaginal yeast infections
• Yeast infections of the penis
• Stuffy or runny nose
• Sore throat
• Changes in urination, such as urinating more often, in larger amounts, or at night

Compare Entresto alternatives
Drug name	Uses	Common side effects	Coupons
Entresto (sacubitril/valsartan)	Heart failure	Cough Dizziness	Entresto coupons
Enalapril	Heart failure  Hypertension Asymptomatic left ventricular dysfunction	Low blood pressure Dizziness Dry cough	Enalapril coupons
Valsartan	Heart failure Hypertension Post-myocardial infarction (MI; heart attack)	Dizziness  Low blood pressure Back pain Joint pain Fatigue  Diarrhea High potassium levels in the blood	Valsartan coupons
Carvedilol	Heart failure Hypertension Left ventricular dysfunction following MI	Dizziness Fatigue  Weakness  Low blood pressure Diarrhea High blood sugar  Weight gain  Slowed heart rate	Carvedilol coupons
Jardiance (empagliflozin)	Heart failure Chronic kidney disease Cardiovascular disease Type 2 diabetes	Urinary tract infections Yeast infections	Jardiance coupons
Farxiga (dapagliflozin)	Heart failure Chronic kidney disease Cardiovascular disease  Type 2 diabetes	Yeast infections of the penis or vagina Stuffy or runny nose Sore throat Changes in urination	Farxiga coupons

Other Entresto alternatives

Other Entresto alternatives include:

• Other ACE inhibitors, such as lisinopril or captopril
• Other ARBs such as losartan or irbesartan
• Other beta blockers such as metoprolol or propranolol
• Aldosterone antagonists such as spironolactone or eplerenone
• Hydralazine and isosorbide dinitrate
• Diuretics such as furosemide or torsemide
• Digoxin
• Corlanor (ivabradine)
• Verquvo (vericiguat)

Natural alternatives to Entresto

Natural alternatives are not included in the standard treatment for heart failure. However, there are natural remedies that can be used along with—but not in place of—standard treatment for heart failure. It’s important that people with heart failure consult with their healthcare provider or cardiologist for medical advice before starting any natural remedies. This is especially important because some natural remedies may interact with prescription heart failure medications or may not be appropriate for certain medical conditions.

Carnitine

Also called L-carnitine, this nutrient is naturally made in the body and is involved in fatty acid metabolism for the body to make energy. There is some evidence that L-carnitine given as a supplement helps with the relief of heart failure, including improvement of energy metabolism in cardiomyocytes (heart muscle cells), which may contribute to the improvement of clinical symptoms and cardiac function.

Magnesium

Magnesium is an important mineral that people get from their diets; however, some people may benefit from additional magnesium supplementation. Due to the nature of the condition, many people with congestive heart failure are deficient in magnesium. There is evidence that magnesium may improve outcomes in people with congestive heart failure by preventing ventricular arrhythmias (a type of abnormal heart rhythm).

Coenzyme Q10

Coenzyme Q10, also called CoQ10, is an antioxidant naturally made in the body and is available as a supplement. In the Q-SYMBIO study, treatment with CoQ10 in addition to standard therapy for people with moderate to severe heart failure was studied. It was concluded that CoQ10 supplementation is safe and well tolerated and is associated with a reduction in symptoms and major adverse cardiovascular events.

Vitamin B1

Also called thiamine, vitamin B1 is a water-soluble vitamin found in foods and is available as a supplement. Vitamin B1 helps the body make food into energy. Studies have shown that people with congestive heart failure who receive thiamine supplementation have improved cardiac function as thiamine acts as a vasodilator (opens blood vessels) and reduces the afterload on the heart (force against which the heart has to contract to eject the blood). Vitamin B1 has also been shown to increase urination and excretion of sodium in urine in people receiving diuretics, which is a great benefit in heart failure patients.

How to switch to an Entresto alternative

1. Talk with a healthcare provider to discuss medical conditions

Before switching from Entresto to a substitute, it’s important that the prescribing healthcare provider is aware of all medical conditions. Some alternatives should be used with caution or avoided with certain medical conditions. 

2. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from Entresto to an alternative, it’s important that the prescribing healthcare provider has reviewed a medication list including prescription drugs and over-the-counter medications—as well as vitamins and supplements. Some alternatives have dangerous drug interactions that must be avoided. 

3. Wait 36 hours when switching from Entresto to an ACE inhibitor

When switching from Entresto to an ACE inhibitor (such as enalapril, ramipril, or lisinopril), there should be a 36-hour washout period. This means that there should be 36 hours between the last Entresto dose and the first ACE inhibitor dose. This washout period helps to minimize the chance of angioedema (swelling under the skin, usually in the lips, tongue, face, or throat), which can be life-threatening.

RELATED: Entresto dosage, forms, and strengths

4. Stop Entresto safely with instructions from a healthcare professional

Only stop taking Entresto if the prescribing healthcare provider has been consulted and decided that stopping the medication is safe. If Entresto is stopped suddenly, the condition of heart failure may worsen. It’s important for a therapy plan to be established prior to stopping Entresto suddenly. Once Entresto is safely stopped and a new medication has been prescribed, always review the patient information for the new medication and consult your healthcare provider with any questions or concerns.