A common condition in the United States, HFrEF accounts for around half of the heart failure cases, estimated to be more than 3 million cases. Acronym for heart failure with reduced ejection fraction, the condition is treated with different medications including Entresto, a prescription medication. This combination medication comprising sacubitril and valsartan, is typically used in patients already receiving standard therapy for heart failure with persistent symptoms or at risk of hospitalization. Due to the nature of the treatment, and the overall costs associated with it, a common question among patients and caregivers is – how much does Entresto cost per month? Following subsections offer in-depth details about the medication, with a clear answer to common questions.
Overview of HFrEF
Ejection fraction refers to the amount of blood pumped out of the heart with each beat. The condition refers to a type of heart failure where the heart muscle becomes weak and does not contract adequately. This results in a condition wherein the actions do not pump blood efficiently, leading to a reduced ejection fraction – which could be less than 40%. HFrEF is attributed to various underlying conditions, including coronary artery disease, high blood pressure, diabetes, and previous heart attacks. Symptoms include shortness of breath, fatigue, swelling in the legs and ankles, and difficulty exercising.
Treatment for HFrEF involves lifestyle changes, such as a heart-healthy diet and regular exercise, and medications such as ACE inhibitors, beta-blockers, and Entresto. In certain instances, surgery may be necessary to treat the underlying cause of HFrEF.
Mechanism of action of Entresto
As outlined, Entresto is a combination medication, comprising sacubitril and valsartan, and the mechanism of action is attributed to the overall effects of the two drugs. This includes an increase in the levels of the hormone natriuretic peptides, improving heart function and reduction of symptoms of heart failure.
Sacubitril is a neprilysin inhibitor, that blocks the action of the enzyme neprilysin. The enzyme breaks down natriuretic peptides, hormones that relax blood vessels and increase urine output. By inhibiting neprilysin, sacubitril increases the levels of natriuretic peptides, and this helps reduce blood pressure, improve heart function, and decrease the workload on the heart.
Valsartan is an angiotensin II receptor blocker (ARB), that blocks the action of the hormone angiotensin II. The hormone is a potent vasoconstrictor, that narrows blood vessels and increases blood pressure. By blocking the action of angiotensin II, valsartan relaxes blood vessels, decrease blood pressure, and improves blood flow to the body’s organs and tissues.
Together, the combination of sacubitril and valsartan reduce the workload on the heart and improve heart function, resulting in better outcomes in patients with heart failure with reduced ejection fraction.
What are the different forms of Entresto and what is the typical dosage?
The drug is available in tablet form and is sold in two strengths, as listed below.
- Entresto 24/26 mg: This strength contains 24 mg of sacubitril and 26 mg of valsartan. It is light peach in color, oval-shaped with “LCI” on one side and “T1” on the other side.
- Entresto 49/51 mg: This strength contains 49 mg of sacubitril and 51 mg of valsartan. It is peach, oval-shaped with “LCI” on one side and “T2” on the other side.
The dosage of Entresto depends on various factors, including the patient’s age, medical history, and the severity of the condition. For heart failure patients, the recommended starting dose is typically 49/51 mg twice daily, that can be increased to 97/103 mg twice daily after 2 to 4 weeks. This, however, depends if the patient tolerates the medication. Patients unable to tolerate the starting dose, are recommended a lowering of the initial dose to 24/26 mg twice daily.
For patients with reduced left ventricular ejection fraction (LVEF) following a heart attack, the recommended starting dose is usually 49/51 mg twice daily, that can be increased to 97/103 mg twice daily after 2 to 4 weeks. The actual dosage of Entresto is determined by healthcare professionals, and this includes modifications of dosage.
What are the commonly reported side effects of Entresto?
All medications come with the possibility of undesirable side effects, and Entresto is no exception. Most of the common side effects reported by patients include the following.
- Low blood pressure (hypotension)
- High levels of potassium in the blood (hyperkalemia)
- Dizziness
- Cough
- Kidney problems
- Fatigue
- Headache
- Diarrhea
- Back pain
- Changes in taste
In addition to the above, Entresto may cause more serious side effects:
- Angioedema (a potentially life-threatening swelling of the face, lips, tongue, or throat)
- Worsening kidney function or kidney failure
- Severe allergic reactions
Drug interactions of Entresto
In addition to undesirable outcomes, medications including Entresto may interact with other medications. This could either increase the risk of side effects or decrease the effectiveness of medications. Medications that may interact with Entresto include the following categories.
- ACE inhibitors: When both medications are taken together, it may increase the risk of angioedema, a potentially life-threatening swelling of the face, lips, tongue, or throat.
- Aliskiren: Use of both drugs may increase the risk of kidney problems, especially in patients with pre-existing kidney disease.
- Potassium-sparing diuretics: This category of drugs, when taken with Entresto may increase the risk of hyperkalemia, a potentially dangerous condition in which there is too much potassium in the blood.
- NSAIDs: Intake of Entresto with nonsteroidal anti-inflammatory drugs may decrease the effectiveness of the drug and increase the risk of kidney problems.
Patients are to inform doctors about all medications in use, including prescription drugs, OTC medications, vitamins, and herbal supplements. Treating specialists may adjust the dose to reduce or mitigate possible effects of interactions. Patients are also to avoid drinking alcohol while on Entresto, as alcohol can reduce blood pressure and increase the possibility of side effects.
How much does Entresto cost per month?
The cost of Entresto varies depending on a number of factors, including the location of purchase, insurance coverage, and the pharmacy. The average retail price of a 30-day supply of Entresto is around $550 to $650. However, patients may pay more or less depending on insurance coverage; for instance, patients with Medicare or Medicaid may pay significantly lesser.
Other programs and coupons also help reduce the cost of Entresto for eligible patients. For instance, the copay card can help eligible patients save on costs. Additionally, some pharmacies and prescription discount programs also offer additional savings.
Options to reduce the cost of Entresto are as listed below:
- Insurance coverage: This may sometimes require prior authorization or may have restrictions on the quantity or duration of treatment.
- Discounts: Discounts and programs help reduce the cost, through copay cards, patient assistance programs, and coupons.
Generic alternatives: Presently there are no generic versions available, but alternative medications may sometimes be prescribed by the specialist.
Education: Master’s in Nursing (MSN) from Johns Hopkins University. Experience: 7 years writing for online health portals and nursing journals, specializing in patient education and chronic illness management.
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