Does Entresto Cause Bradycardia?
Entresto (sacubitril/valsartan) is not directly associated with causing bradycardia based on available evidence. The provided guidelines and research do not identify bradycardia as a recognized adverse effect of this medication.
Evidence Analysis
Direct Evidence on Entresto and Bradycardia
No documented bradycardia risk: The available research on sacubitril/valsartan does not list bradycardia among its adverse effects or safety concerns 1, 2, 3.
Clinical trial safety data: Meta-analyses and clinical trials examining Entresto have focused on arrhythmias like atrial fibrillation and atrial flutter, but bradycardia has not emerged as a significant concern 3.
Mechanism of action: Entresto works through angiotensin receptor blockade (valsartan) and neprilysin inhibition (sacubitril), neither of which directly affects heart rate or conduction system function in a way that would cause bradycardia 2.
Drugs That DO Cause Bradycardia
For context, medications with well-established bradycardia risk include:
Beta-blockers: Cause bradycardia through SA and AV nodal effects 4.
Nondihydropyridine calcium channel blockers (diltiazem, verapamil): Produce bradycardia and AV block 4.
Digoxin: Can cause bradyarrhythmias, particularly in toxicity 4.
Amiodarone and sotalol: Associated with bradycardia requiring pacemaker implantation 4.
Ivabradine: Specifically designed to slow heart rate, with excess bradycardia as a known risk when combined with other rate-lowering agents 4.
Important Clinical Considerations
Hypotension, not bradycardia: The main cardiovascular concern with Entresto is hypotension, particularly in patients with systolic blood pressure ≤100 mmHg, which is a contraindication for initiation 5.
Combination therapy caution: If a patient on Entresto is also taking beta-blockers or other rate-controlling medications (common in heart failure management), bradycardia could occur from those agents, not from Entresto itself 4.
No conduction system effects: Unlike drugs that affect SA or AV nodal function, Entresto does not have direct chronotropic or dromotropic effects 1.