Your eligible HFrEF patients may experience the benefits of ENTRESTO® regardless of their previous therapy.1

Transitioning to ENTRESTO® in symptomatic patients with fewer symptoms and complications can make the process even smoother.1 Here is a checklist of important points to remember and things to consider when switching to ENTRESTO® in place of ACEi.

Stop ACEi2,3
Allow for a 36-hour washout period when switching from an ACEi1,4
The combination of ENTRESTO® with an ACEi is contraindicated due to the increased risk of angioedema4
Inform patients to dispose of their ACEi medication safely (preferably with their local pharmacist)4
Prescribe an initial dose of ENTRESTO® after consulting with the SmPC1
Uptitrate every three to four weeks, as tolerated, until the target dose of ENTRESTO® is reached1,4

Recommended ENTRESTO® posology in HFrEF patients switching from ACEi

This dosing schedule shows how eligible patients with HFrEF could be titrated to the target dose of ENTRESTO®.4

Recommended starting dose for patients not taking or on low dose of ACEi/ARB

50 mg

To be taken twice daily, as tolerated by the patient.
Follow up in 3-4 weeks.

Recommended starting dose (or uptitrate from 50 mg)

100 mg

To be taken twice daily, as tolerated by the patient.
Follow up in 3-4 weeks.


200 mg

To be taken twice daily, as tolerated by the patient.

Which patients can benefit from ENTRESTO®?

A switch to ENTRESTO® may be beneficial for more HFrEF patients than you might think. You may encounter these four HFrEF patients who can all benefit from ENTRESTO®:


Consider starting ENTRESTO® in symptomatic patients with fewer symptoms and complications1,5-7


ENTRESTO® has no upper age limit4,8


ENTRESTO® can be used in the following patients:†4,9

  • eGFR 60-90 ml/min/1.73 m2: no dose adjustment
  • eGFR 30-60 ml/min/1.73 m2: half of the starting dose


  • ENTRESTO® can be used from SBP ≥100 mmHg‡2,10
  • For patients with SBP 100 – 110 mmHg consider a starting dose of 50 mg4


As there is very limited clinical experience in patients with severe renal impairment (eGFR <30 ml/min/1.73 m2) (see section 5.1), ENTRESTO® should be used with caution and half of the starting dose is recommended.3

ENTRESTO® should not be initiated unless SBP is ≥100 mmHg for adult patients. A starting dose of 50 mg twice daily should be considered for patients with SBP ≥100 to 110 mmHg. For full guidance on management strategies for hypotension, see ENTRESTO® SmPC4


ACEi: angiotensin-converting enzyme inhibitor; eGFR: estimated glomerular filtration rate; HF: heart failure; HFrEF: heart failure with reduced ejection fraction; SBP: systolic blood pressure


  1. Sauer Al, et al. Practical guidance on the use of sacubitril/valsartan for heart failure. Heart Fail Rev. 2019;24(2): 167-176.
  2. McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
  3. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation 2022;145(18):895-e1032.
  4. ENTRESTO® Summary of Product Characteristics, Dec 2023.
  5. McMurray J, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004.
  6. DeVore AD, et al. Initiation of Angiotensin-Neprily sin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial (supplementary). JAMA Cardiol. 2020:5(2):202-207.
  7. Solomon SD, et al. Efficacy of Sacubitril/alsartan Relative to a Prior Decompensation: The PARADIGM-HF Trial. JACC Heart Fail. 2016;4(10):816-822.
  8. Jhund PS, et al. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HE. Eur Heart J. 2015;36(38): 2576-2584.
  9. Damman K, et al. Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure. JACC Heart Fail. 2018;6(6): 489-498.
  10. Böhm M, et al. Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitri/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF. Eur Heart J. 2017;38(15): 1132-1143.
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