Entresto 24-26 mg Contains 26 mg of Valsartan
Entresto 24-26 mg contains 26 mg of valsartan component. 1, 2
Understanding Entresto Dosage Formulations
Entresto is a fixed-dose combination medication containing two active ingredients: sacubitril and valsartan. The medication is available in three specific dosage strengths:
- Entresto 24/26 mg: contains 24 mg sacubitril and 26 mg valsartan
- Entresto 49/51 mg: contains 49 mg sacubitril and 51 mg valsartan
- Entresto 97/103 mg: contains 97 mg sacubitril and 103 mg valsartan
Clinical Significance and Dosing
The naming convention for Entresto directly indicates the exact amount of each component in the tablet. When you see "Entresto 24-26 mg," this refers to a tablet containing 24 mg of sacubitril and 26 mg of valsartan.
Important dosing considerations:
- Entresto tablets should not be split due to potential issues with dose accuracy and medication stability 1
- The lowest available strength (24/26 mg) is typically used as a starting dose for patients who:
- Are transitioning from low doses of ACEIs/ARBs
- Have severe renal impairment (eGFR <30 mL/min/1.73m²)
- Have moderate hepatic impairment
- Are elderly (≥75 years)
- Are ACEI/ARB naïve 3
Titration Protocol
The American College of Cardiology/American Heart Association guidelines recommend the following titration schedule:
- Start with 24/26 mg twice daily for vulnerable patients
- Titrate to 49/51 mg twice daily as tolerated
- Target dose is 97/103 mg twice daily 3
In clinical trials, the target dose of 97/103 mg twice daily provided the greatest mortality benefit, but real-world data shows that many patients remain on lower doses 3, 4.
Clinical Implications
Understanding the exact valsartan content is important because:
The valsartan component in Entresto 24/26 mg (26 mg twice daily = 52 mg total daily) is significantly lower than the target dose of valsartan monotherapy for heart failure (160 mg twice daily = 320 mg total daily) 3
When transitioning patients from valsartan monotherapy to Entresto, dose equivalence must be considered to avoid underdosing the RAS-inhibiting component 3
Monitoring for hypotension, renal dysfunction, and hyperkalemia is essential, particularly when initiating or uptitrating Entresto 1
Remember that Entresto tablets should not be confused with valsartan monotherapy tablets, as the dosing and clinical effects are different due to the dual mechanism of action with sacubitril.