Entresto for dogs

In this article:

• What is Entresto used for in dogs?
• Is Entresto safe for dogs?
• Entresto dosage for dogs
• Entresto alternatives for dogs
• Summary

In this article

• What is Entresto used for in dogs?
• Is Entresto safe for dogs?
• Entresto dosage for dogs
• Entresto alternatives for dogs
• Summary

Entresto is used in people to treat congestive heart failure (CHF). Currently, veterinarians do not use Entresto in dogs, but it may be more commonly used by veterinarians in the future.

Two recent studies have shown that Entresto could be an effective treatment for canine heart failure. However, veterinarians already have several effective treatments for this type of heart disease. They have experience with these drugs and guidelines to help them make the right medication choices. Any veterinarian can prescribe Entresto, but the lack of veterinary guidelines and the high cost are important issues.

Entresto combines two drugs, valsartan and sacubitril. Valsartan is an angiotensin II receptor blocker (ARB). It widens blood vessels, lowering blood pressure to make it easier for the heart to pump blood. Sacubitril is a new and patented drug that belongs to a family of medications called neprilysin inhibitors. Sacubitril widens blood vessels and increases the body’s elimination of salt and water. This lowers blood volume and pressure, allowing the heart to pump blood more easily.

RELATED: Save up to 80% on Entresto

What is Entresto used for in dogs?

Entresto is a heart failure treatment not currently used in dogs, though a veterinarian can prescribe it. Research has shown that Entresto is effective in dogs with heart failure due to mitral valve insufficiency, the most common cause of heart failure in dogs. Dosages have not been standardized. Side effects in dogs are unknown at this time. 

Congestive heart failure

Entresto is used in people to treat heart failure as a preferred treatment depending on the nature of the heart failure and other aspects of the overall situation. Research and experience have shown that the active ingredients in Entresto, sacubitril/valsartan, significantly increase positive outcomes, including life expectancy, hospital visits, and overall cost, compared to angiotensin-converting enzyme inhibitors (ACE) or ARBs.

At least two veterinary studies have shown that sacubitril/valsartan is effective in dogs with heart failure due to a heart valve problem called myxomatous mitral valve disease (MMVD). This is the most commonly diagnosed cardiovascular disease in dogs. When MMVD occurs, the mitral valve which separates the heart’s top left chamber (left atrium) from the bottom left chamber (left ventricle) becomes leaky. Normally, the mitral valve opens when the left atrium can pump blood into the left ventricle. It then slaps shut, and the left ventricle pumps blood to the rest of the body. In MMVD, the mitral valve is “floppy.” It doesn’t fully close. Some of the blood in the left ventricle flows back into the left atrium (mitral regurgitation). As a result, there is backflow and the pumping action of the heart is not as efficient. Over time, the heart starts getting bigger (ventricular enlargement) and changes shape to compensate. Called cardiac remodeling, this eventually leads to fluid buildup and death as it progresses.

Mitral valve disease is responsible for about 80% of heart failure cases in dogs. Specifically, the drug has been shown to prevent or reverse cardiac remodeling in dogs with MMVI. Slowing or reversing cardiac remodeling is key in treating heart failure and keeping the patient alive. 

Veterinarians do not commonly use Entresto in dogs. Dosages have not been established, and the price is very high—about $9,000 annually. No one has studied the side effects in dogs, either. Additionally, angiotensin receptor blockers such as valsartan are not part of the treatment guidelines for either canine heart failure or canine mitral valve disease. 

Is Entresto safe for dogs?

Healthcare professionals do not know if Entresto is safe for dogs. In two clinical studies of Entresto in dogs, side effects were not reported. Veterinarians do not commonly use angiotensin receptor blockers like valsartan, so veterinary resources do not include these drugs or their safety information in their manuals.

Side effects of Entresto in dogs

Veterinary professionals do not know what side effects Entresto, valsartan, or sacubitril cause in dogs. They can guess, but no study has shown the adverse effects of these drugs in dogs.

In humans, the most common side effects reported by at least 1 in 20 people in clinical trials are:

• Low blood pressure
• High potassium (hyperkalemia)
• Cough
• Dizziness
• Kidney failure

Entresto’s most serious side effects in people include:

• Angioedema (swelling of the face and throat)
• Dangerously low blood pressure
• Kidney dysfunction
• Renal failure
• High potassium
• Fetal injury

Interactions of Entresto with other pet meds

Veterinary science hasn’t determined Entresto’s most relevant drug interactions in dogs or other animals. 

In humans, Entresto cannot be safely taken with:

• Blood pressure drugs called ACE inhibitors (the first-line treatment for heart failure in dogs)
• The blood pressure drug aliskiren (not generally used in dogs)

In people healthcare professionals generally avoid using Entresto with:

• Other angiotensin receptor blockers
• Potassium-sparing diuretics like spironolactone (another common treatment for heart failure in dogs)
• Potassium supplements or potassium-based drugs

Entresto dosage for dogs

Currently, there are no standardized Entresto dosages for dogs. Entresto has been studied in two clinical studies. Both used 20 mg/kg given 12 hours apart as the target dosage. One review of emerging heart failure treatments recommends that dogs should be started on a dose of 5 or 10 mg/kg given every 12 hours. 

Can dogs overdose on Entresto?

There is little information about Entresto overdoses in either dogs or people. An Entresto overdose will likely cause significantly low blood pressure, possibly low enough to require medical attention. No maximum dosage of Entresto has been determined for dogs. 

Can I give my dog Entresto every day?

In people, Entresto is taken twice daily for weeks, months, or even years. People can take twice-daily doses of Entresto if it works and doesn’t cause serious side effects. Clinical trials in people lasted for over three years without finding serious side effects due to long-term use. 

Veterinary professionals don’t know if it’s safe for dogs to take Entresto daily over a long period. Two clinical studies of Entresto in dogs lasted only 30 days. 

How to give your dog Entresto

Entresto only comes in fixed doses for people, so getting the right dose for a dog will be challenging. Entresto tablets are not scored, so they can’t be precisely divided into half. The two studies of Entresto in dogs used specially prepared sacubitril/valsartan capsules to control doses.

Any veterinarian who prescribes Entresto will give detailed instructions on administering the medicine. Give the dose precisely as instructed. Follow the dosing schedule rigorously. Do not give more medicine to the dog than instructed.

Entresto alternatives for dogs

Heart failure in dogs, whether it’s caused by mitral valve disease or an enlarged left ventricle (the heart chamber that pumps blood to the body), involves a combination of drugs:

Diuretics

• Diruetics help canines eliminate urine. All dogs with heart failure will be given furosemide or a similar drug to reduce blood volume and fluid buildup (edema). This decreases blood pressure and makes it easier for the heart to pump blood into the blood vessels.

Hypertension drugs 

• Known as ACE inhibitors, this drug class includes the medications enalapril or benazepril. These drugs widen blood vessels, decrease blood pressure, and make it easier for the heart to pump blood.

Pimobendan

• Another standard component of managing canine heart failure is pimobendan. Used only in animals, the primary effect of pimobendan is to increase the ability of heart muscles to contract. This strengthens the heart and allows it to pump more blood with each heartbeat.

Spironolactone

• Spironolactone is a diuretic like furosemide. It causes dogs to urinate but keeps potassium levels normal. It’s not very powerful, but it has been shown to slow the progress of heart failure and increase life expectancy. 

Beta blockers

• Beta blockers are used in people with a certain type of heart failure to improve outcomes and extend lifespans. They’re not well-studied in dogs, but some veterinary heart specialists may include them in managing canine heart failure.

Heart rhythm drugs

• A veterinarian will prescribe a drug to normalize heartbeats if the heartbeat or heart rate is irregular (arrhythmia). The drug used will depend on the nature of the heart rhythm problem.

Veterinarians will most likely use furosemide, pimobendan, and an ACE inhibitor. Other drugs might be added to this regimen.

Summary

Veterinarians do not commonly use Entresto in dogs since it is not well-studied and can’t be used with standard treatments for canine heart failure. A veterinarian can use it, but ask the veterinarian why it’s the best treatment for your dog.