An ARNI heart-failure medicine
Sacubitril/valsartan
A two-in-one heart-failure medicine that improves symptoms and survival — used in place of an ACE inhibitor or ARB, and never alongside one.
What is Sacubitril/valsartan?
Sacubitril/valsartan (brand Entresto) is a combined heart-failure tablet that lowers strain on the heart and helps the body clear excess fluid and salt. It is used instead of an ACE inhibitor or ARB — the two must never be taken together — and improves symptoms and survival in heart failure with a weakened heart muscle. Blood pressure, kidney function and potassium are monitored.
Education and reference only. This is a plain-language guide to Sacubitril/valsartan — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Sacubitril/valsartan is a modern medicine for chronic heart failure where the heart’s pumping is weakened (reduced ejection fraction). It combines two ingredients — sacubitril (a neprilysin inhibitor) and valsartan (an angiotensin-receptor blocker) — in one tablet, and it has been shown to reduce hospital admissions and improve survival compared with an ACE inhibitor. It is usually started in place of an existing ACE inhibitor or ARB, under specialist or GP guidance, and taken twice daily.
How it works
The medicine works on two fronts. The valsartan part blocks angiotensin, a hormone that tightens blood vessels and makes the body retain salt and water, so blood vessels relax and fluid load falls. The sacubitril part blocks an enzyme (neprilysin) that normally breaks down the body’s own beneficial "natriuretic peptides" — hormones that widen blood vessels and help the kidneys shed salt and water. Preserving these peptides adds a helpful effect on top of the valsartan, easing the heart’s workload.
What it treats
Conditions Sacubitril/valsartan is used for
Practical use
How to take Sacubitril/valsartan
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it twice a day as prescribed; it replaces — never joins — an ACE inhibitor or ARB.
- If switching from an ACE inhibitor, leave at least 36 hours between the last ACE-inhibitor dose and the first dose of this medicine.
- Report swelling of the face, lips, tongue or throat, or difficulty breathing, as an emergency (999).
- Avoid potassium supplements and potassium-based salt substitutes unless advised, and have your blood pressure, kidneys and potassium monitored.
- Rise slowly from sitting or lying if you feel dizzy, especially when starting or increasing the dose.
Weighing it up
Advantages & disadvantages of Sacubitril/valsartan
Advantages
- Reduces heart-failure hospital admissions and improves survival compared with an ACE inhibitor.
- Two complementary actions in a single twice-daily tablet.
- A key part of modern heart-failure treatment for a weakened heart.
Disadvantages
- Must never be combined with an ACE inhibitor, with a 36-hour switching gap (angioedema risk).
- Can lower blood pressure and raise potassium; needs monitoring.
- More expensive than older options and avoided in pregnancy.
Practical use
Good to know
The single most important rule is that sacubitril/valsartan must never be taken with an ACE inhibitor (such as ramipril), and a gap of at least 36 hours is left when switching from one to the other — combining them sharply raises the risk of a serious swelling reaction (angioedema). It can lower blood pressure, raise potassium and affect kidney function, so these are checked when starting and adjusting. Report swelling of the face, lips, tongue or throat urgently. It is not started until any ACE inhibitor has been stopped for a day and a half, and it is avoided in pregnancy.
Who should not take it / use with caution
- Anyone taking an ACE inhibitor (it must be stopped for at least 36 hours first), or with a history of angioedema.
- People with significantly low blood pressure, high potassium, or significant kidney impairment, until assessed.
- Pregnancy and breastfeeding — it is avoided; women who could become pregnant should use reliable contraception.
Monitoring
- Blood pressure
- Kidney function and potassium (before and after starting/adjusting)
- Symptoms of heart failure and of angioedema
Side effects
- Common: low blood pressure (dizziness), a raised potassium level, and reduced kidney function.
- Cough is less likely than with an ACE inhibitor.
- Rarely, angioedema — swelling of the face, lips, tongue or throat — which is a medical emergency.
Key interactions
- ACE inhibitors — must not be combined (serious angioedema risk); a 36-hour gap is required when switching.
- Other medicines that raise potassium (potassium-sparing diuretics such as spironolactone, potassium supplements) add to the risk of high potassium.
- Anti-inflammatory painkillers (NSAIDs) can reduce its effect and stress the kidneys; care with lithium.
Available as: Tablets (combining the two ingredients).
Answers
Sacubitril/valsartan: frequently asked questions
Can I take sacubitril/valsartan with my ramipril?
No — this is critical. Sacubitril/valsartan must never be taken together with an ACE inhibitor such as ramipril, because the combination greatly increases the risk of a dangerous swelling reaction (angioedema). When switching from an ACE inhibitor, at least 36 hours must pass between the last ACE-inhibitor dose and the first dose of this medicine.
How is it different from an ACE inhibitor?
It contains an ARB (valsartan) plus a second ingredient (sacubitril) that preserves the body’s own beneficial heart-protective hormones — an extra action that ACE inhibitors and plain ARBs do not have. In suitable people with a weakened heart, it has been shown to reduce hospital admissions and improve survival more than an ACE inhibitor.
What should I do if my face or lips swell?
Treat it as an emergency — call 999. Swelling of the face, lips, tongue or throat can signal angioedema, which can affect breathing. Stop the medicine and seek immediate help; tell the team you take sacubitril/valsartan.
Is Entresto the same as sacubitril/valsartan?
Yes — sacubitril/valsartan is the active-ingredient name and Entresto is the brand. It is a fixed combination of the two ingredients in one tablet.
Authoritative sources
- BNF: Sacubitril with valsartan.
- electronic Medicines Compendium (SmPC): Entresto.
- NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure.
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