Are you a Veterinarian?
What Is Entresto (Sacubitril/Valsartan)?
Entresto is an angiotensin receptor–neprilysin inhibitor (ARNI) combining sacubitril (neprilysin inhibition) and valsartan (ARB). The dual mechanism supports vasodilation, natriuresis/diuresis, and suppression of maladaptive RAAS signaling. Though not FDA-approved for animals, early evidence suggests clinical value in dogs with mixomatous mitral valve disease (MMVD), particularly stages B2–C.
Why Consider It in Canine MMVD?
Entresto may reduce remodeling by limiting RAAS drive while enhancing natriuretic peptide pathways, potentially decreasing LA/LV enlargement and improving forward flow.
- Reduces afterload and wall stress
- Blunts neurohormonal progression pathways
- May slow chamber dilation in ongoing remodeling
How We Use It
- Start: 5 mg/kg PO BID
- Titrate: to 10 mg/kg PO BID if tolerated
What to Monitor / What to Watch For
- Blood pressure: hypotension risk, especially after titration
- Renal values: BUN/creatinine before starting and at rechecks
- Electrolytes: particularly potassium
- Clinical response: resting RR, exercise tolerance, appetite
We generally avoid concurrent ACE-I unless there is a specific clinical rationale to prevent overlapping RAAS blockade.
Evidence Snapshot
- Stage C MMVD studies show improved cardiac size/function when added to standard care.
- Stage B2 placebo-controlled study supports safety and biomarker improvement.
- Healthy-dog research suggests improved renal perfusion.
Clinical Takeaway
Entresto is not a first-line medication for every dog, but it can be a valuable adjunct in carefully selected MMVD cases showing persistent remodeling or insufficient response to conventional therapy.
Are you a pet caretaker?
What Is Entresto?
Entresto is a heart medication made from two drugs that work together to help the heart pump with less effort. One part relaxes blood vessels and helps remove extra fluid, and the other blocks hormones that add extra strain to the heart.
Why Might My Dog Need It?
In mitral valve disease, the valve leaks more and more over time. That makes the heart work harder and slowly get bigger. Entresto can help reduce this extra strain and slow the worsening of the disease, especially when the usual medications are no longer enough.
- Helps the heart work more efficiently
- May slow the disease progression
- Can improve comfort and quality of life
How Is It Given?
Entresto is usually given twice a day. We start with a lower dose and increase it slowly if your dog handles it well.
What Checkups Are Needed?
Because this medicine can affect blood pressure and kidneys, your dog needs periodic checkups to make sure everything stays safe. We monitor blood pressure and run bloodwork as needed.
Is It Safe?
So far, studies show most dogs tolerate Entresto very well. Side effects are uncommon, and monitoring helps keep it safe.
Bottom Line
Entresto isn’t right for every dog, but for certain dogs with mitral valve disease or heart failure, it can provide an extra level of support. We’re always happy to talk about whether it’s a good option for your dog.
