Entresto interactions: Alcohol, medications, and other factors

Entresto interactions with other medications  

Before you start treatment with Entresto, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Entresto interacts with supplements, herbs, or vitamins, see the “Entresto and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Entresto. Keep in mind that this table doesn’t include all drugs that may interact with Entresto. Some of these interactions are described in detail just below in “Drug interactions in depth.”

When to avoid Entresto

In some cases, factors or conditions could prevent your doctor from prescribing Entresto due to the risk of harm. These are known as contraindications. The contraindications of Entresto include:

Having diabetes and taking aliskiren

You should not take Entresto if you’re taking aliskiren (Tekturna) and have diabetes. Aliskiren belongs to a drug class called direct renin inhibitors. Doctors typically prescribe aliskiren to treat high blood pressure.

Entresto and aliskiren both work in similar ways in the kidneys and can lower blood pressure. As a result, taking them together can increase your risk of kidney problems, low blood pressure, and high potassium levels. In addition, taking these drugs together doesn’t have any benefit for heart failure treatment.

Before starting treatment with Entresto, be sure to tell your doctor if you’re taking aliskiren. They’ll likely have you stop taking aliskiren before you start treatment with Entresto.

Taking an ACE inhibitor

Doctors will not prescribe Entresto in combination with an ACE inhibitor. This type of medication is prescribed for high blood pressure and heart failure.

Taking Entresto with an ACE inhibitor can increase your risk of a serious allergic reaction called angioedema (swelling under your skin). Angioedema generally affects the face, hands, or feet. You may also notice a red, itchy rash in the affected areas. Angioedema can cause swelling of the throat and may be life threatening for some people.

Below are examples of ACE inhibitors that can interact with Entresto:

• lisinopril (Zestril)
• quinapril
• ramipril (Altace)
• enalapril (Vasotec)
• captopril
• fosinopril

Note that ACE inhibitors are in several combination blood pressure medications. A few examples include:

• quinapril with hydrochlorothiazide (Accuretic)
• benazepril with hydrochlorothiazide (Lotensin HCT)
• captopril with hydrochlorothiazide

Before you start treatment with Entresto, it’s important to tell your doctor if you take an ACE inhibitor. They’ll likely have you wait at least 36 hours after your last dose of ACE inhibitor to take Entresto. Your doctor will tell you when to stop taking the ACE inhibitor and start Entresto.

Having a history of angioedema after taking an ACE inhibitor or ARB

People who have had angioedema when taking an ACE inhibitor or ARB may have a higher risk of developing angioedema with Entresto. Due to this risk, your doctor likely will not prescribe Entresto if you’ve had angioedema with an ACE inhibitor or ARB in the past.

Having had an allergic reaction to Entresto or any of its ingredients

If you have had an allergic reaction to Entresto or any of its ingredients, your doctor will likely not prescribe Entresto. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Entresto, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Entresto.

Entresto interaction with alcohol

There aren’t any known interactions between Entresto and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Entresto treatment.

This is because drinking alcohol while taking the drug may worsen some of Entresto’s side effects, such as dizziness. For details about side effects of Entresto, see this article.

Alcohol use can also worsen the condition you’re taking Entresto to treat. For example, high alcohol consumption may worsen heart failure.

If you have questions about drinking alcohol while taking Entresto, talk with your doctor or pharmacist.

Drug interactions in depth

Here’s a closer look at certain drug interactions of Entresto.

Angiotensin II receptor blockers (ARBs)

ARBs are typically prescribed to treat high blood pressure or heart failure.

Interaction result: Taking Entresto with ARBs may increase the risk of side effects of Entresto or the ARB.

Interaction explained: Valsartan, one of the active ingredients in Entresto, is also an ARB. Taking Entresto with another ARB may increase the total level of ARB in your body. A higher ARB level may increase your risk of side effects of Entresto or the other ARB, such as low blood pressure or kidney problems. To learn about Entresto’s side effects, see this article.

Examples of ARB drugs: Here are some ARBs that may interact with Entresto:

• losartan (Cozaar)
• candesartan (Atacand)
• valsartan (Diovan)
• olmesartan (Benicar)
• irbesartan (Avapro)

Note that ARBs are in several combination blood pressure mediations. A few examples include:

• candasartan with hydrochlorothiazide (Atacand HCT)
• olmesartan with hydrochlorothiazide (Benicar HCT)
• valsartan with hydrochlorothiazide (Avapro HCT)

Steps you or your doctor may take: Due to the risk of side effects, doctors will not prescribe an ARB if you’re taking Entresto. Be sure to tell your doctor if you’re taking an ARB before starting treatment with Entresto. They’ll likely have you stop taking the ARB before beginning treatment with Entresto.

To learn more about Entresto and ARBs, talk with your doctor or pharmacist.

Potassium-sparing diuretics

Potassium-sparing diuretics are also known as water pills. They reduce the amount of fluid in your body without losing potassium, an important nutrient. Doctors may prescribe diuretics to treat heart failure, high blood pressure, or edema (fluid buildup).

Interaction result: Taking Entresto with potassium-sparing diuretics can cause an increase in the potassium level in your blood.

Interaction explained: Entresto and potassium-sparing diuretics can raise your potassium level when taken individually. Taking these drugs together may increase your risk of high potassium.

Examples of potassium-sparing diuretics: Here are some potassium-sparing diuretics that may interact with Entresto:

• spironolactone (Aldactone)
• eplerenone (Inspra)
• triamterene (Dyrenium)
• amiloride (Midamor)

Steps you or your doctor may take: Tell your doctor if you’re taking a potassium-sparing diuretic before starting treatment with Entresto. They’ll likely want to order blood tests to monitor your potassium levels closely.

If you have questions about Entresto and potassium-sparing diuretics, talk with your doctor or pharmacist for more information.

Lithium (Lithobid)

Lithium is prescribed to treat certain mental health conditions, such as bipolar disorder.

Interaction result: Taking Entresto with lithium could increase your risk of side effects of lithium. These may include nausea and vomiting, diarrhea, or drowsiness.

Interaction explained: Taking Entresto and lithium together could cause a buildup of lithium in your body. In some cases, the drug could rise to unsafe levels causing lithium toxicity (serious side effects).

Steps you or your doctor may take: If you’re taking lithium with Entresto, your doctor may recommend a lower dose of lithium. They’ll likely want to regularly monitor the level of lithium in your blood to make sure it doesn’t get too high.

If you experience side effects of lithium, tell your doctor right away. They’ll recommend whether it’s safe to take these medications together.

Entresto and other interactions

Entresto may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Entresto.

Entresto interactions with supplements

Before you start treatment with Entresto, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Because of how Entresto works, it can increase the level of potassium in your blood. Taking Entresto with potassium supplements can cause the potassium level in your blood to become too high.

For this reason, you shouldn’t take potassium supplements unless your doctor recommends doing so. If you need to take a potassium supplement while taking Entresto, your doctor may order blood tests to monitor your potassium levels.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Entresto and herbs

There are no specific reports of herbs interacting with Entresto. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Entresto treatment.

Entresto and vitamins

There are no specific reports of vitamins interacting with Entresto. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Entresto.

Entresto interactions with food

Salt substitutes that contain potassium can interact with Entresto. Using these salt substitutes while taking Entresto can cause the potassium level in your blood to become too high. You should not use salt substitutes, such as Nu-Salt or NoSalt, unless your doctor says it’s OK.

Talk with your doctor or pharmacist if you have questions about interactions with other food while you’re taking Entresto.

Entresto and vaccines

There aren’t any known interactions between Entresto and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Entresto and lab tests

Entresto isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

ENTRESTO INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Entresto. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Entresto. The impact of cannabis may affect how well you stick to your Entresto treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Entresto and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Entresto. Before you take this drug, be sure to talk with your doctor about your health history. Entresto may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Entresto include:

• Kidney or liver problems: Tell your doctor if you have kidney or liver problems before starting treatment with Entresto. Your kidneys and liver help clear drugs, including Entresto, from your body. If you have kidney or liver problems, Entresto can build up in your body increasing your risk of side effects. If you have liver problems or severe kidney problems, your doctor will likely prescribe a lower dose of Entresto for you. (Learn about Entresto dosages in this article.)
• History of angioedema: If you’ve had angioedema after taking an ACE inhibitor or ARB in the past, your doctor will likely not prescribe Entresto for you. Your doctor can recommend other treatments that are a better choice to treat your heart failure. For details, see “When to avoid with Entresto.”
• Hereditary angioedema: If you have hereditary angioedema, your doctor will likely not prescribe Entresto for you. Taking Entresto may increase your risk of having an angioedema episode. Your doctor can recommend other options that are safer for you.
• Allergic reaction: If you’ve had an allergic reaction to Entresto or any of its ingredients, your doctor will likely not prescribe Entresto. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether it’s safe to take Entresto while breastfeeding. Because of the risk of serious side effects in breastfed infants, your doctor will likely recommend that you do not breastfeed during Entresto treatment. If you’re breastfeeding or planning to, talk with your doctor before taking Entresto. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Entresto should not be taken during pregnancy. Entresto has a boxed warning for the risk of fetal harm. For details, see “Boxed warning: Fetal harm” at the beginning of this article. If you’re pregnant or planning to become pregnant, tell your doctor before starting Entresto. They can advise you on the right treatment plan for you.

FAQs about Entresto and interactions

Here are some frequently asked questions about Entresto and possible interactions.

What pain relievers can I use if I’m taking Entresto?

Acetaminophen (Tylenol) is an over-the-counter (OTC) pain reliever that’s considered safe to take with Entresto. There aren’t any reports of acetaminophen interacting with Entresto.

Topical pain relievers are also safe to use while taking Entresto. Examples of these include creams that contain menthol, capsaicin, or lidocaine. These typically are helpful for joint pain in the hands, feet, hips, or back.

However, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), typically should not be used during treatment with Entresto. This is because NSAIDs may increase your risk of serious kidney problems.

Before taking acetaminophen or any OTC medication, talk with your doctor or pharmacist. They can advise you on whether the medication is safe to take with Entresto and what the right dosage is.

Is there an interaction between Entresto and melatonin?

No, there are no specific reports of Entresto interacting with melatonin (an OTC sleep aid).

However, either drug individually can sometimes cause dizziness. You may have an increased risk of this side effect if you take melatonin during Entresto treatment. (For information about Entresto’s side effects, see this article.)

If you’re interested in taking melatonin, you should check with your doctor first.

Preventing interactions

You can take certain steps to help prevent interactions with Entresto. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Entresto label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Entresto doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Entresto by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today 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.