The Role of Entresto (Sacubitril / Valsartan)
What is Entresto used for? One prescription drug used to treat heart failure is called Entresto. It consists of two active ingredients: valsartan and sacubitril. These combinational ingredients contribute to blood vessel relaxation, blood pressure reduction, and heart strain reduction.
Entresto is mainly recommended for heart failure with reduced ejection fraction (HFrEF). It is a condition that is characterized by a diminished heart’s ability to pump blood efficiently.
Shortness of breath, exhaustion, and edema are among the symptoms of heart failure that it helps alleviate. Additionally, it has been demonstrated to increase overall survival and decrease hospitalizations for heart failure.
Is Entresto a beta-blocker or a diuretic?
Entresto is not a diuretic or a beta-blocker. This drug is a mixture of valsartan and sacubitril.
An angiotensin receptor neprilysin inhibitor (ARNI) is sacubitril. It functions by preventing the breakdown of advantageous peptides that aid in blood vessel relaxation and fluid accumulation by the enzyme neprilysin. This lessens heart failure symptoms and enhances cardiac function.
An angiotensin II receptor blocker (ARB) is valsartan. By inhibiting the effects of the hormone angiotensin II, which constricts blood vessels, it helps relax blood vessels, lower blood pressure, and lessen the strain on the heart.
Entresto is not classified as a beta-blocker, like metoprolol, or a diuretic, like furosemide, which is frequently used to treat heart failure.
How Entresto Affects Blood Pressure and Kidney Function
Entresto’s combination of valsartan and sacubitril can have a major impact on renal function and blood pressure.
Effect on Blood Pressure
Entresto primarily works by lowering blood pressure through the following mechanisms:
The hormone angiotensin II, which causes blood vessels to contract, is inhibited by the medication valsartan, also known as an angiotensin II receptor blocker, or ARB. Valsartan lowers blood pressure by relaxing and widening blood vessels by blocking this hormone.
The enzyme neprilysin, which breaks down natural compounds like natriuretic peptides that aid in blood vessel relaxation, is inhibited by sacubitril, a neprilysin inhibitor. These peptides continue to function when neprilysin is inhibited, helping to dilate blood vessels and so lowering blood pressure.
Sacubitril and valsartan act together to improve cardiac function, particularly in patients with heart failure, by lowering afterload, or the resistance the heart must overcome when pumping blood.
Because of this, Entresto usually lowers blood pressure, which is advantageous for people who have heart failure or high blood pressure (hypertension). Blood pressure should be watched nonetheless, as some people may experience abnormally low blood pressure, particularly after beginning medication.
Effect on Kidney Functioning:
By decreasing blood flow to the kidneys, ARBs such as valsartan can impact renal function. Serum creatinine and potassium levels in the blood may rise as a result, and the kidney’s capacity to filter waste may also be compromised.
Acute kidney injury (AKI) or a worsening of pre-existing renal disorders may result in certain situations, particularly in individuals who already have kidney difficulties.
Since neprilysin inhibition may increase the synthesis of specific chemicals (such as natriuretic peptides) that impact kidney blood flow and filtration, sacubitril (a neprilysin inhibitor) may also impact kidney function.
Even though they are generally healthy, increased amounts of these compounds can cause electrolyte imbalances or other kidney-related adverse effects.
While taking Entresto, doctors frequently advise regular blood tests to check serum creatinine, potassium levels, and glomerular filtration rate (GFR); blood pressure monitoring to make sure it doesn’t fall too low, which could disrupt kidney perfusion.
Can Entresto cause kidney problems?
Yes, some people may get renal issues as a result of administering Entresto. Particularly in people who already have kidney disease, the drug may decrease blood flow to the kidneys, raising creatinine levels and impairing kidney function.
Additionally, it may result in harmful electrolyte abnormalities like hyperkalemia or elevated potassium. When taking Entresto, it’s crucial to regularly check potassium, serum creatinine, and kidney function, especially in people who already have kidney disease or are at risk for developing it.
Does Entresto cause low blood pressure?
Yes, especially when beginning treatment or increasing the dosage, Entresto may result in hypotension or low blood pressure.
Sacubitril and valsartan together relax blood vessels and reduce blood pressure, which can cause hypotension in certain people. It’s crucial to regularly check blood pressure to prevent abrupt reductions.
Can Entresto cause swelling (angioedema)?
Indeed, angioedema—a rare but serious side effect of Entresto that is characterized by swelling, usually of the face, lips, tongue, or throat—can occur. If angioedema affects breathing, it is crucial to stop taking Entresto and seek medical help right away.
Drug Interactions
Like any other medication, Entresto also possesses some drug interactions, like:
- Entresto with ACE inhibitors, such as enalapril and lisinopril, can raise the risk of renal issues and angioedema. ACE inhibitors should not be taken with entresto.
- When taken with Entresto, medications such as amiloride or spironolactone can raise the risk of hyperkalemia, or elevated potassium levels. It is crucial to regularly check potassium levels.
- NSAIDs, such as naproxen and ibuprofen, can decrease Entresto’s effectiveness and raise the risk of renal damage, particularly when taken with diuretics.
Entresto may raise blood levels of lithium, which can be toxic; regular monitoring of lithium levels is required. - Aliskiren, a direct renin inhibitor, should not be taken with Entresto because it may increase the risk of kidney dysfunction, hyperkalemia, and low blood pressure.
- When combined with diuretics (such as furosemide), there is an increased risk of hypotension, dehydration, and kidney dysfunction.
Cost and Availability
Major pharmacies offer Entresto at neighborhood pharmacies, hospital pharmacies, and internet pharmacies. To find the best drugstore to get the prescription, you can also consult your healthcare provider or insurance company.
A number of factors, including your location, insurance coverage, and the pharmacy where you buy it, might affect the price of Entresto. Entresto can be pricey on average; without insurance, a monthly supply often costs $400 to $600 USD. However, insurance coverage, manufacturer discounts, or generic equivalents can result in lower costs.
Entresto is currently unavailable in a generic form, and due to its high effectiveness, its price is quite high.
Understanding the Cost of Entresto: Insurance
For those who are eligible, Entresto may be covered by a variety of insurance programs, such as Medicare and private insurance, particularly if it is given for heart failure or another similar illness.
Out-of-pocket expenses, however, may still differ according to the formulary, co-pays, and deductibles of your insurance plan.
Co-pay Assistance: Novartis, the company that makes Entresto, provides qualified patients with a co-pay assistance program that can help reduce the cost if you don’t have insurance or have significant out-of-pocket expenses.
Medicare and Medicaid: Medicare Part D often covers Entresto, though the precise cost may vary depending on the formulary used by the plan. States may have different requirements for Medicaid coverage.
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FAQs:
You can take Entresto with or without food. There are no dietary restrictions, so the choice is based on convenience or personal taste. Just make sure you take it daily in the same manner.
Generally speaking, you can take Entresto if you have diabetes, but you should consult your doctor first. For people with diabetes, it’s critical to regularly monitor blood sugar and kidney health because Entresto can impact potassium levels and renal function. Prior to beginning any new drug, always get your doctor’s approval.
Along with other heart medications, Entresto can be taken, but only under a medical professional’s Certain combinations, including those involving aliskiren or ACE inhibitors, are not advised because of the higher risk of adverse consequences like low blood pressure or kidney issues. To ensure safe drug management, always get advice from your doctor.
People with mild to severe kidney disease can use Entresto, but kidney function must be closely monitored. People with severe kidney illness might not be able to use it. If you have kidney issues, you should always speak with your doctor before beginning Entresto since you might need to change your dosage or try another treatment.
References:
Entresto medicine overview update X-44-G
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