Can't find or afford Entresto? Here are real alternatives your doctor may prescribe, including ACE inhibitors, ARBs, and SGLT2 inhibitors for heart failure.
If you're having trouble filling your Entresto prescription — whether because of a pharmacy stock-out, cost issues, or side effects — you may be wondering if there's something else you can take instead.
The good news: there are several effective alternatives to Entresto for managing heart failure. The key is working with your doctor to find the right one for your specific situation. Never switch medications on your own — always talk to your healthcare provider first.
Entresto (Sacubitril/Valsartan) is an angiotensin receptor-neprilysin inhibitor (ARNI) used to treat heart failure. It's made by Novartis and comes in three tablet strengths: 24/26 mg, 49/51 mg, and 97/103 mg.
Entresto works through a dual mechanism:
Together, these two components work to lower blood pressure, reduce fluid buildup, and protect the heart from further damage. For a deeper dive, check out our guide on how Entresto works.
In the landmark PARADIGM-HF clinical trial, Entresto was shown to be superior to Enalapril (an ACE inhibitor) in reducing the risk of cardiovascular death and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF).
If you can't take Entresto, your doctor may consider one of the following alternatives. Each works differently, and the best choice depends on your specific type of heart failure, other medications you're taking, and your overall health.
Drug class: Angiotensin-converting enzyme (ACE) inhibitor
How it works: Enalapril blocks the enzyme that produces angiotensin II, a substance that narrows blood vessels and increases blood pressure. By blocking this enzyme, Enalapril helps blood vessels relax and reduces the strain on the heart.
Why it's a common alternative: Enalapril was the gold standard for heart failure treatment before Entresto came along. It was the comparator drug in the PARADIGM-HF trial. While Entresto showed better outcomes, Enalapril is still an effective treatment — and it's available as an inexpensive generic, often costing less than $10 per month.
Important note: You cannot take an ACE inhibitor at the same time as Entresto. If switching from Entresto to Enalapril (or vice versa), you must wait at least 36 hours between the last dose of one and the first dose of the other to avoid the risk of angioedema.
Drug class: Angiotensin receptor blocker (ARB)
How it works: Valsartan blocks the angiotensin II receptor directly, preventing blood vessel constriction and reducing aldosterone secretion. This lowers blood pressure and reduces fluid retention.
Why it's a common alternative: Valsartan is one of the two active ingredients in Entresto, so it provides part of Entresto's benefit on its own. It's commonly prescribed when patients can't tolerate ACE inhibitors (for example, due to a persistent cough, a common ACE inhibitor side effect). Generic Valsartan is widely available and affordable.
Drug class: Sodium-glucose co-transporter 2 (SGLT2) inhibitor
How they work: Originally developed for type 2 diabetes, SGLT2 inhibitors have been shown to provide significant benefits in heart failure — even in patients without diabetes. They work by helping the kidneys remove excess sodium and glucose through urine, which reduces fluid overload and blood pressure.
Why they're recommended: Both Farxiga and Jardiance are now included in major heart failure treatment guidelines as part of the "four pillars" of guideline-directed medical therapy (GDMT) for HFrEF. They're not a direct one-to-one substitute for Entresto, but they can be used alongside other heart failure medications or as an alternative pillar of therapy if Entresto isn't available. Brand-name pricing can be high ($500+ per month), but manufacturer savings programs and insurance coverage can reduce costs significantly.
Drug class: Beta blocker (with alpha-blocking activity)
How it works: Carvedilol slows the heart rate, reduces blood pressure, and blocks the harmful effects of stress hormones (adrenaline and noradrenaline) on the heart. This helps the heart pump more efficiently over time.
Why it matters: Carvedilol isn't a direct substitute for Entresto — it works through a completely different mechanism. However, it's one of the four pillars of heart failure treatment. If you're already taking Carvedilol alongside Entresto and need to stop Entresto temporarily, continuing your beta blocker is essential. Generic Carvedilol is very affordable, typically less than $15 per month.
Before switching to a completely different drug, ask your doctor about generic Sacubitril/Valsartan. After Entresto's patent expired in July 2025, generic versions became available from multiple manufacturers. The generic is bioequivalent to brand-name Entresto and significantly cheaper — as low as $45 per month with a discount card.
If your pharmacy is out of brand-name Entresto, the generic may still be in stock. Use Medfinder to check availability near you.
Entresto is a first-line treatment for heart failure with reduced ejection fraction, and its combination of Sacubitril and Valsartan offers unique benefits that other drugs don't fully replicate. But if you can't access Entresto right now, there are well-studied alternatives that can help manage your condition effectively.
The most important thing is to never stop taking your heart failure medication without talking to your doctor. If cost is the barrier, read our guide on saving money on Entresto. If availability is the issue, check Medfinder or read our tips on finding Entresto in stock near you.
Your doctor can help you find the best path forward based on your specific needs. Don't wait — call them today if you're having trouble filling your prescription.
You focus on staying healthy. We'll handle the rest.
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