Key takeaways
- Entresto (sacubitril/valsartan) has interactions with alcohol, other medications, and some supplements. For example, Entresto can interact with potassium supplements and ibuprofen (Advil, Motrin).
- It may be safe to take Entresto with Plavix (clopidogrel) or Eliquis (apixaban). There are no known interactions between Entresto and these drugs. However, Entresto can interact with some other medications used to manage heart problems, including ACE inhibitors and ARB drugs.
- Before you start treatment with Eliquis, be sure to tell your doctor about your health history, including any medications you might be taking. They’ll let you know whether Entresto is safe for you to take.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Entresto’s possible interactions. And for more information about Entresto, including details about its uses, see this Entresto overview article.
Before you start taking Entresto, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. To learn whether Entresto interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Entresto?” section.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The following table lists drugs that may interact with Entresto. Keep in mind that this table does not include all drugs that may interact with Entresto. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| angiotensin converting enzyme inhibitors | • lisinopril (Zestril, Qbrelis) • ramipril | can increase the risk of angioedema* |
| angiotensin II receptor blockers (ARBs) | • losartan (Cozaar) • valsartan (Diovan) | can increase the risk of side effects from Entresto and ARBs |
| nonsteroidal anti-inflammatory drugs | • aspirin • ibuprofen (Advil, Motrin) | can increase the risk of kidney problems |
| potassium-sparing diuretics (water pills) | • eplerenone (Inspra) • spironolactone (Aldactone, CaroSpir) | can increase the risk of developing a high potassium level |
| aliskiren (Tekturna) | — | can increase the risk of side effects from Entresto and aliskiren in certain people* |
| lithium (Lithobid) | — | can increase the risk of side effects from lithium |
* To learn more about this risk, see the “When should I avoid Entresto?” section.
Certain health conditions or other factors could raise your risk of harm if you take Entresto. In such cases, your doctor may not prescribe Entresto for you. These are known as contraindications. The following list includes contraindications of Entresto.
If you have diabetes and take aliskiren: If you have diabetes and take aliskiren (Tekturna), your doctor will likely not prescribe Entresto. This is because you may have a raised risk of kidney problems and other side effects with Entresto. You can ask your doctor about other treatments that may be better options for you.
If you take an ACE inhibitor drug: If you take an angiotensin converting enzyme (ACE) inhibitor drug, such as lisinopril (Zestril), your doctor likely won’t prescribe Entresto for you. This is because the combination could raise your risk of angioedema (a type of severe allergic reaction). If your doctor has you switch to Entresto from an ACE inhibitor, you should wait at least 36 hours after stopping the ACE inhibitor before taking Entresto.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Entresto or any of its ingredients, your doctor likely won’t prescribe Entresto. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
If you’ve had angioedema with an ACE inhibitor or angiotensin II receptor blocker (ARB): If you’ve had angioedema (a type of severe allergic reaction) when taking an ACE inhibitor or ARB drug in the past, your doctor will likely not prescribe Entresto. This is because taking Entresto could cause angioedema again.
Before you start taking Entresto, talk with your doctor if any of these factors apply to you. Your doctor can determine whether Entresto is safe for you to take.
Entresto is not known to interact with alcohol. But Entresto and alcohol can both cause dizziness. So you may be more likely to experience dizziness if you drink alcohol during Entresto treatment.
It’s also important to note that excessive alcohol use may worsen heart failure over time. (Entresto is prescribed for certain people with heart failure.)
If you have questions about consuming alcohol while taking Entresto, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Entresto.
Interaction with NSAIDs
Entresto can interact with nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to treat pain and inflammation (swelling).
Examples of NSAIDs include:
What could happen
Taking Entresto with an NSAID can raise your risk of kidney problems, including acute kidney failure.
You may have a higher risk of kidney problems if you’re age 65 years or older and you take Entresto with an NSAID. You may also be at higher risk if you take diuretic medications (water pills) or if you become dehydrated through severe vomiting or diarrhea. And if you already have kidney problems, these may get worse if you take Entresto with an NSAID.
What you can do
If you have any of the risk factors noted, you should not take an NSAID with Entresto without talking with your doctor first. If your doctor recommends taking Entresto with an NSAID, they may prescribe a lower dose of Entresto or the NSAID for you. You should not take a higher dose of either medication than your doctor prescribes.
Talk with your doctor or pharmacist before taking an over-the-counter NSAID, such as aspirin or ibuprofen, with Entresto. They can determine whether the drug is safe to take with Entresto and whether you should take a lower dose of the NSAID.
Your doctor will likely monitor your kidney function if you take this combination of drugs.
If you take Entresto and an NSAID together, tell your doctor right away if you have symptoms of kidney problems. These may include dark-colored urine, urinating less than usual, swelling of your lower legs, itchy skin, and confusion.
If you have questions about taking Entresto with NSAIDs, talk with your doctor or pharmacist.
Interaction with potassium-sparing diuretics
Entresto can interact with potassium-sparing diuretics, which are a type of water pill. They may be used to treat edema (fluid buildup), heart failure, and high blood pressure. These diuretics help your kidneys get rid of fluid without getting rid of potassium.
Examples of potassium-sparing diuretic medications include:
- amiloride (Midamor)
- eplerenone (Inspra)
- spironolactone (Aldactone, CaroSpir)
- triamterene (Dyrenium)
What could happen
Entresto and potassium-sparing diuretics can both cause a high potassium level. So taking these drugs together can raise your risk of this side effect.
You may have a higher risk of a high potassium level if you have kidney problems or diabetes and you take Entresto with a potassium-sparing diuretic. You may also be at higher risk if you have an adrenal gland problem called hypoaldosteronism or if you follow a diet that’s high in potassium.
What you can do
If you take Entresto with a potassium-sparing diuretic, your doctor may prescribe a lower dose of Entresto or the diuretic for you. You should not take a higher dose of either medication than your doctor prescribes. Your doctor will likely order frequent blood tests to check your potassium level if you take this combination of drugs.
If you take Entresto and a potassium-sparing diuretic together, tell your doctor right away if you have symptoms of a high potassium level. These may include weakness, fatigue (low energy), muscle cramps, heart palpitations, nausea, and vomiting.
If you have questions about taking Entresto with a potassium-sparing diuretic, talk with your doctor or pharmacist.
Interaction with lithium
Entresto can interact with lithium (Lithobid), which is used to treat certain mental health conditions, such as bipolar disorder.
What could happen
Taking Entresto with lithium could cause lithium to build up in your body. This could raise your risk of side effects from lithium, such as diarrhea, vomiting, muscle weakness, and coordination problems. If your lithium level becomes too high, this can cause serious side effects, such as organ damage. It can even lead to death.
What you can do
If you take Entresto with lithium, your doctor may prescribe a lower dose of lithium for you. You should not take a higher dose of either medication than your doctor prescribes. If you take lithium with Entresto, your doctor will likely order frequent blood tests to check your lithium level.
Entresto may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. Keep reading for details. Note that the following information doesn’t include all other possible interactions with Entresto.
Does Entresto interact with supplements?
Before you start taking Entresto, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.
Entresto can interact with potassium supplements. Taking Entresto with this type of supplement can cause the level of potassium in your blood to become too high. You should not take Entresto with a potassium supplement unless your doctor recommends it. If you do take Entresto with a potassium supplement, your doctor will likely order frequent blood tests to check your potassium level.
If you have questions about other interactions that may affect you, talk with your doctor or pharmacist.
Entresto and herbs
There are currently no reports of Entresto interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products with Entresto.
Entresto and vitamins
There are currently no reports of Entresto interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during your Entresto treatment.
Does Entresto interact with food?
Entresto can interact with salt substitutes that contain potassium, and consuming them during Entresto treatment can cause a high potassium level. You should not use salt substitutes with Entresto unless this is recommended by your doctor. If you do take salt substitutes, your doctor may order frequent blood tests to check your potassium level.
If you have questions about interactions with other foods during treatment with Entresto, talk with your doctor.
Does Entresto interact with vaccines?
There are currently no reports of Entresto interacting with vaccines. If you have questions about getting certain vaccines during Entresto treatment, talk with your doctor.
Does Entresto interact with lab tests?
There are currently no reports of Entresto interacting with lab tests. If you have questions about having certain lab tests during treatment with Entresto, talk with the healthcare professional ordering the test.
Does Entresto interact with cannabis or CBD?There are currently no reports of Entresto interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Entresto.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Entresto. Before taking Entresto, talk with your doctor about your health history. They’ll determine whether Entresto is right for you.
Health conditions or other factors that might interact with Entresto include:
Liver or kidney problems: Your liver and kidneys help clear Entresto from your system. If you have liver or kidney problems, Entresto could build up in your body. This could raise your risk of side effects. If you have liver problems or severe kidney problems, your doctor may prescribe a lower dose of Entresto for you. But it’s not known whether Entresto is safe for people with severe liver problems.
Taking aliskiren (Tekturna): If you take aliskiren and have diabetes, your doctor will likely not prescribe Entresto for you. This is because you may have a higher risk of kidney problems and other side effects with Entresto. If you take aliskiren and have kidney problems, your doctor may not prescribe Entresto for you. This is because Entresto could make your kidney problems worse. Talk with your doctor about other treatment options that may be safer for you.
Taking an ACE inhibitor: If you take an angiotensin converting enzyme (ACE) inhibitor drug, your doctor will likely not prescribe Entresto for you. For more information, see the “When to avoid Entresto” section.
Pregnancy: Entresto is not safe to take during pregnancy. In fact, the drug has a boxed warning for the risk of fetal harm. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Boxed warning” section at the top of the article. And if you’re pregnant or planning a pregnancy, talk with your doctor about other treatment options for your condition.
Breastfeeding: It’s not known whether it’s safe to take Entresto while breastfeeding. But because of the risk of serious side effects in children who are breastfed, your doctor will likely recommend that you do not breastfeed while taking Entresto. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Entresto or any of its ingredients, your doctor will likely not prescribe Entresto. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Past angioedema: If you’ve had angioedema (a type of severe allergic reaction) when taking an ACE inhibitor or angiotensin II receptor blocker, your doctor will likely not prescribe Entresto. This is because taking Entresto could cause angioedema again.
If you have hereditary angioedema, your doctor may not prescribe Entresto for you. Taking the drug may raise your risk of having an episode of angioedema. Talk with your doctor about other treatments that may be better choices for you.
Find answers to some frequently asked questions about Entresto and possible interactions.
Is it safe to take Entresto and metoprolol succinate together?
Yes, it should be safe to take Entresto with metoprolol succinate (Kapspargo sprinkle, Toprol XL). There’s no known interaction between these drugs.
Entresto is used to treat certain types of heart failure in adults and some children. Metoprolol succinate is used to treat angina (a type of chest pain), high blood pressure, and heart failure in adults. It’s also used to treat high blood pressure in certain children.
It’s not uncommon for doctors to prescribe these drugs together.
If you have other questions about taking Entresto and metoprolol succinate together, talk with your doctor or pharmacist.
Can you take zinc with Entresto?
Yes, you can likely take zinc with Entresto. There’s no known interaction between Entresto and zinc supplements. Zinc supplements may be used to support your immune system, as well as your eye, skin, and heart health.
If you have questions about taking zinc with Entresto, talk with your doctor or pharmacist.
Is there an interaction between Entresto and atorvastatin?
No, there’s no known interaction between Entresto and atorvastatin (Lipitor).
Entresto is prescribed to treat certain types of heart failure in adults and certain children. Atorvastatin (Lipitor) is prescribed to lower cholesterol levels in adults and certain children. It’s also used to help prevent heart disease, heart attack, stroke, and hospitalization for heart failure in certain people.
It’s not uncommon for doctors to prescribe Entresto and atorvastatin together. If you have questions about taking these drugs together, talk with your doctor or pharmacist.
Taking certain steps can help you avoid interactions with Entresto. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - What to do if you start taking a new drug during Entresto treatment.
It’s also important to understand Entresto’s
If you have difficulty reading or understanding this information, your doctor or pharmacist can help.
Taking Entresto exactly as prescribed can also help prevent interactions.
If you still have questions about Entresto and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Do I need to tell you if I change my diet while taking Entresto?
- Does my risk of interactions depend on my Entresto dose?
- How will I be monitored if I take Entresto with an interacting drug or condition?
To learn more about Entresto, see these articles:
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.