Canada Pharmacy Depot

How to Take Entresto Properly

Thursday 4 April 2024
6 minute(s) read

Table of Contents

I. Entresto Dosages

i. Entresto Dosages for Adults

ii. Entresto Dosages for Children

II. How to Take Entresto

III. Entresto Overdose

IV. Tips to Remember to Take Entresto

V. Conclusion

Entresto is a breakthrough prescription medication that can help manage heart failure in adults and children. [1] However, to maximize its benefits and minimize health risks, it must be taken carefully and as prescribed.

This article provides an overview of FDA-recommended Entresto dosages, administration methods, risks of overdose, and essential tips for using this medication safely and effectively.

Entresto Dosages

Entresto is a combination medication used to treat heart failure. It contains two active ingredients - sacubitril and valsartan.

  • Sacubitril is a neprilysin inhibitor. It works by blocking the action of neprilysin, an enzyme that normally breaks down peptides like natriuretic peptides. This allows beneficial natriuretic peptides to have greater effects on the body, such as relaxing blood vessels, promoting sodium excretion, and inhibiting the production of certain hormones that increase blood pressure and strain the heart.
  • Valsartan is an angiotensin II receptor blocker (ARB). It works by blocking the binding of angiotensin II to receptors in the body. This prevents angiotensin II from exerting its effects, such as constricting blood vessels and activating aldosterone, which leads to sodium retention and fluid buildup. [2]

Entresto comes in three strengths. The dosages are determined by the amount of each medication contained in each tablet, with sacubitril stated first, followed by valsartan. 

  • 24 mg of sacubitril and 26 mg of valsartan (24/26 mg tablet)
  • 49 mg of sacubitril and 51 mg of valsartan (49/51 mg tablet)
  • 97 mg of sacubitril and 103 mg of valsartan (97/103 mg tablet) [1]

Entresto Dosages for Adults

When starting Entresto, your doctor will prescribe a low dose. The dose will be gradually increased (titrated) over 2 to 4 weeks until you reach the standard recommended dose of 97/103 mg taken twice daily. This initiation period allows your doctor to monitor how you tolerate Entresto and watch for any serious side effects, like swelling under the skin (angioedema), before increasing the dose. [1]

The exact titration schedule will depend on your medical history:

  • Standard titration is 49/51 mg twice daily for 2 to 4 weeks. After this period, the dose is increased to the maintenance dose of 97/103 mg twice daily.
  • If you have liver dysfunction, kidney disease, or have been taking low doses of ACE inhibitors or ARBs, your starting dose may be lower at 24/26 mg twice daily for 2 to 4 weeks. Your doctor will double the dose every 2 to 4 weeks until you reach the target maintenance dose.
  • If you're switching from an ACE inhibitor to Entresto, your doctor will have you stop the ACE inhibitor and wait 36 hours before starting Entresto. This wash-out period prevents any interactions between the drugs. [1]

Entresto Dosages for Children

a child taking a medication

Entresto dosing for children is based on the child's weight. Like adults, the goal is to gradually increase the dose to reach the standard maintenance dose through a process called titration. However, children may need a more gradual titration schedule to reach the full maintenance dose. [1]

In certain cases, the initial doses of Entresto may be lower for children. 

  • Children who are not on normal doses of ACE inhibitors or ARBs
  • Children who have kidney issues
  • Children with liver impairment [1]

The chart below provides general titration guidance based on a child's body weight. Doses will be increased gradually every two weeks until the target maintenance dose is achieved. [1]

Initial Dosage Titration in Children One Year and Older*


Starting Dosage (Taken Twice Daily)

Second Dosage (Taken Twice Daily)

Final Dosage (Taken Twice Daily)

Children less than 40 kg

1.6 mg per kg

2.3 mg per kg

3.1 mg per kg

Children between 40 kg and 50 kg

24/26 mg

49/51 mg

72/78 mg

Children above 50 kg

49/51 mg

72/78 mg

97/103 mg


How to Take Entresto

Entresto is an oral tablet that is typically taken twice daily with or without food. For those unable to swallow a tablet, such as young children or individuals with swallowing difficulties, a doctor or pharmacist can prepare an oral suspension, a liquid form of the medication that can be swallowed. [1]

If you miss a dose of Entresto, take it as soon as you remember. However, if it is nearly time for your next dose, take your next dose at the scheduled time and skip the missed dose. Do not double up or take extra doses to make up for a missed dose. [1]

Entresto Overdose

There is not much data available on Entresto's overdose. However, some studies on healthy volunteers give us an idea of what to expect.

  • In one study, volunteers took a single high dose of 583 mg of sacubitril and 617 mg of valsartan. This was well tolerated.
  • In a second study, volunteers took high doses of 437 mg of sacubitril and 463 mg of valsartan daily for 14 days. Again, this was well tolerated. [1]

The most likely effect of an overdose is low blood pressure since Entresto lowers blood pressure. If you suspect you or someone you know has overdosed on Entresto, seek emergency medical care right away. [1]

Tips to Remember to Take Entresto

a woman taking Entresto tablets

To get into an easy routine with Entresto, follow these tips:

  • Set a consistent time: Pick a specific time of day that works for your schedule and make Entresto part of your daily regimen. For example, take it along with breakfast or before bedtime. Setting an established time to take your Entresto each day will help you remember your dose and turn it into a habit.
  • Connect it to a daily activity: Tie Entresto to an activity you already do every day, like brushing your teeth, taking a shower, or making coffee. Pairing it with an existing habit will serve as a reminder and help incorporate your medication into your normal routine.
  • Have a plan when traveling: If traveling, make sure to pack enough Entresto to last your whole trip, plus extra in case of delays. Carrying it in your carry-on rather than checked luggage will ensure you have it when you need it. You don't want to risk missing doses due to lost or delayed bags.
  • Keep a medicine calendar: Marking down each dose on a calendar you keep next to your medication bottles provides an easy way to monitor that you're staying on schedule. Having a visual record can serve as a reference if you ever question whether you took your daily Entresto. [3]


Taking Entresto correctly is critical for effectively managing heart failure and avoiding complications. By carefully following the recommended dosage, administration guidelines, and safety warnings, you can reap the maximum benefits of this treatment while reducing risks.

Contact your doctor or healthcare team for advice if you have any questions or concerns about your Entresto regimen.

To learn more about Entresto, visit our Entresto blog for more helpful topics.

The content provided in this article is based on thorough research and in some cases, reviewed by a medical professional. Our goal for the information is to provide helpful, general health informational. It is not intended as a substitute for professional medical advice.