Sacubitril: What It Does and What You Need to Know

Sacubitril is part of a combination medicine commonly used for chronic heart failure. Taken alone, it is not used; instead it comes combined with valsartan as sacubitril/valsartan (brand name Entresto). The pair helps the heart by boosting natural hormones that remove extra salt and water while lowering strain on the heart. That reduces symptoms like shortness of breath and fatigue, and can cut hospital visits.

How it works

Sacubitril blocks an enzyme called neprilysin, which breaks down helpful peptides known as natriuretic peptides. Those peptides relax blood vessels, lower blood pressure, and reduce sodium retention. Valsartan blocks the angiotensin receptor to further lower blood pressure and protect the heart. Together, they work better than some older medicines for certain people with heart failure with reduced ejection fraction.

Doctors prescribe sacubitril/valsartan when standard therapy like ACE inhibitors, ARBs, beta-blockers, and diuretics do not control symptoms or to reduce hospital risk. Your clinician will check blood pressure, kidney function, and potassium levels before and during treatment.

Common side effects

include low blood pressure, dizziness, elevated potassium, and changes in kidney tests. Rare but serious risks are angioedema (swelling of face or throat) and severe allergic reactions. If you faint, have trouble breathing, or notice big swelling, seek emergency care.

Important interactions and rules: Do not take an ACE inhibitor and sacubitril together. You need a 36-hour gap after stopping an ACE inhibitor before starting sacubitril/valsartan to lower angioedema risk. Watch other meds that raise potassium (like spironolactone or potassium supplements), NSAIDs, and lithium. Tell your doctor all prescriptions and over-the-counter products you use.

Typical dosing starts low and increases as tolerated. Your doctor will switch you from an ACE inhibitor or ARB with proper timing. Do not change the dose or stop the drug without medical advice.

Practical tips: take the medicine at about the same time each day, with or without food. Rise slowly from sitting to reduce dizziness. Keep a blood pressure and pulse log for clinic visits. Store the pills away from heat and moisture.

When to call your doctor: worsening shortness of breath, fainting, sudden swelling, very low blood pressure, or marked change in urine output. These can signal a serious problem.

Questions to ask your clinician: Is sacubitril/valsartan right for my type of heart failure? What tests will I need? How will you adjust other blood pressure meds? What signs should make me stop the drug?

Pregnant people should not take sacubitril; valsartan and similar drugs can harm the fetus. If you plan pregnancy, discuss safe alternatives. Also, let the doctor know if you have liver disease, low blood pressure, or recent strokes. Keep an updated medication list to avoid risky mixes. Finally, ask about any cost assistance programs if price is a concern.

Your care team will guide the safe use.