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ENTRESTO® replaces ACEi/ARB treatment for heart failure patients with reduced ejection fraction with a simple 1 or 2 step titration1

  • On low dose ACEi/ARB
  • With moderate renal impairment (eGFR 30-60 ml/min/1.73 m2)
  • With severe renal impairment (eGFR <30 ml/min/1.73 m2)
  • With moderate hepatic impairment (Child-Pugh B Classification)
  • With systolic blood pressure 100 mmHg to 110 mmHg
  • Dose should be doubled every 3-4 weeks to a target dose of 97 mg/103 mg b.d., as tolerated by the patient


  • On high dose ACEi/ARB*
  • Dose should be doubled every 2-4 weeks to a target dose of 97 mg/103 mg b.d., as tolerated by the patient


  • Target dose, as tolerated by the patient

* No washout needed when switching from an ARB to ENTRESTO®


ENTRESTO® has a safety and tolerability profile comparable to enalapril2 MONITORING: Patients on Entresto should be monitored similar to patients on ACE inhibitors and/or ARBs.

* Please refer to individual SmPC of ACE inhibitor / ARB for guidance on current dosing level
† There is very limited clinical experience in patients with severe renal impairment (eGFR <30 ml/min/1.73 m2). Entresto should be used with caution and a starting dose of 24 mg/26 mg twice daily is recommended.1

Prescribe ENTRESTO as your first choice with confidence1

In clinical trials, ENTRESTO generally demonstrated comparable safety and superior efficacy to ACEi (enalapril)1-3

Image of a house, representing PARADIGM-HF*: Most commonly reported AEs with Entresto were hypotension, hyperkalaemia and renal impairment.

PARADIGM-HF:* Most commonly reported AEs with ENTRESTO were hypotension, hyperkalaemia and renal impairment1,2

  • Fewer patients taking ENTRESTO discontinued therapy due to an AE during the double-blind period: 10.7% vs 12.3% with enalapril2
  • While more patients experienced symptomatic hypotension with ENTRESTO than with ACEi (enalapril), there was no increase in the rate of discontinuation due to hypotension-related effects (0.9% vs 0.7%; P=0.38)2

Image of a hospital, representing PIONEER-HF.


  • ENTRESTO showed significantly greater reductions in NT-proBNP and exploratory clinical outcomes, with comparable safety vs ACEi (enalapril), when initiated in hospital following haemodynamic stabilisation after an ADHF‡3

ENTRESTO® (sacubitril/valsartan) is licensed in adult patients for treatment of symptomatic chronic heart failure with reduced ejection fraction1


To be eligible for reimbursement patients must meet the following criteria:

  • LVEF of ≤35%, and
  • Symptomatic (NYHA functional class II - IV) and
  • Receiving stable dose of ACE inhibitor or an ARB prior to initiation of Entresto®
  • Systolic blood pressure ≥100mmHg
  • Serum potassium (K+) ≤5.4mmol/L
  • Starting dose of Entresto®

Please provide the below supporting information where available:

  • Current heart failure medications
  • Demographics - gender, age
  • Laboratory tests, where available


Starting Entresto®:

Entresto® contains valsartan and therefore should not be co-administered with another ACEi or ARB containing product1
For patients previously on an ACEi, stop ACEi for 1.5 days (36 hours) before starting Entresto®1


Monitoring: Patients on Entresto® should be monitored, like patients on an ACE inhibitor and/or ARB.1 For full prescribing information please refer to the SmPC.


ENTRESTO is indicated in adult patients for the treatment of symptomatic chronic heart failure with reduced ejection fraction.1

* PARADIGM-HF was a multinational, randomised, double-blind trial comparing ENTRESTO to enalapril in 8,442 symptomatic (NYHA Class II-IV) HFrEF patients (LVEF ≤40%, amended later to ≤35%). For the primary endpoint, composite of CV death or first HF hospitalisation, ENTRESTO was superior to enalapril (P<0.0001). The median follow-up duration was 27 months.2
† PIONEER-HF was a prospective, multicentre, double-blind, randomised, controlled trial designed to assess the safety, tolerability, and efficacy of in-hospital initiation of ENTRESTO compared with enalapril in 881 adult patients in the United States with HFrEF (EF ≤40% and NTproBNP ≥1600 pg/mL or BNP ≥400 pg/mL) stabilised during hospitalisation for ADHF. The primary endpoint was time-averaged proportional change in NT-proBNP from baseline through Weeks 4 and 8. An exploratory clinical endpoint was the outcome of a composite of serious clinical events, which included death, rehospitalisation for heart failure, implantation of a left ventricular assist device, and inclusion on the list of patients eligible for heart transplantation3
‡ Primary endpoint: Time-averaged proportional change in NT-proBNP concentration from baseline through Weeks 4 and 8.3

ACEi, angiotensin-converting enzyme inhibitor; ADHF, acute decompensated heart failure; AE, adverse event; ARB, angiotensin receptor blocker; CV, cardiovascular; EF, ejection fraction; eGFR, estimated glomerular filtration rate; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; K+, potassium; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal-pro-brain natriuretic peptide; NYHA, New York Heart Association; SBP, systolic blood pressure.


  1. ENTRESTO® Summary of Product Characteristics. Accessed on December 2021
  2. McMurray JJ, et al. N Engl J Med 2014;371:993–1004.
  3. Velazquez EJ., et al. N Engl J Med 2019; 380:539-548
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April 2022 | IE 172547

Reporting of side effects
Adverse events (side effects) can be reported via the HPRA. Reporting forms and information can be found at Adverse events could also be reported to Novartis preferably via or by email: [email protected] or by calling (01) 2080 612. For information on any of our medicinal products please contact Medical Information on (01) 260 1255.


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