Entresto, a medication developed for human heart disease, is gaining attention in veterinary medicine for its benefits in canine patients. This combination drug helps manage certain heart conditions in dogs, aiming to improve quality of life and potentially extend lifespan.
What Entresto Is and Its Primary Use
Entresto is a combination medication containing two active ingredients: sacubitril and valsartan. Sacubitril is a neprilysin inhibitor, while valsartan is an angiotensin II receptor blocker (ARB). This dual-action approach targets different pathways involved in heart disease progression.
The primary use of Entresto in dogs is for managing congestive heart failure (CHF). CHF occurs when the heart cannot pump enough blood, leading to fluid buildup in the lungs, abdomen, or other tissues. In dogs, CHF often stems from chronic valvular heart disease (CVHD), particularly myxomatous mitral valve disease (MMVD), which accounts for about 80% of canine heart failure cases. MMVD involves the thickening and degeneration of the heart’s mitral valve, causing it to leak.
Entresto may also address dilated cardiomyopathy (DCM), a disease where the heart’s chambers enlarge and the heart muscle weakens, reducing its pumping ability. By addressing these issues, Entresto aims to alleviate CHF symptoms like coughing, difficulty breathing, and exercise intolerance. The medication also works to slow the progression of harmful cardiac remodeling, which is the enlargement and reshaping of the heart that occurs in response to chronic heart disease.
How Entresto Works in Dogs
Entresto’s effectiveness stems from the complementary actions of its two components: sacubitril and valsartan. Sacubitril acts as a neprilysin inhibitor, preventing the breakdown of beneficial natriuretic peptides. These peptides reduce fluid retention, promote sodium and water excretion, and relax blood vessels. By allowing these peptides to remain active longer, sacubitril helps counteract the negative effects of heart failure.
Valsartan, the second component, functions as an angiotensin II receptor blocker (ARB). Angiotensin II is a hormone that causes blood vessels to narrow, increases blood pressure, and contributes to harmful heart muscle remodeling. Valsartan blocks these receptors, reducing its detrimental effects. This leads to wider blood vessels, lower blood pressure, and less strain on the heart, making it easier for the heart to pump blood. Together, sacubitril and valsartan work synergistically to improve the heart’s pumping efficiency, reduce fluid overload, and mitigate the progression of heart disease.
Administering Entresto and Monitoring Your Dog
When administering Entresto to your dog, follow your veterinarian’s specific instructions precisely regarding dosage and frequency. Entresto is typically given as a tablet, often twice daily. While there are no standardized dosages for dogs, veterinarians may start with a lower dose and adjust as needed. Consistency in timing is helpful for maintaining steady medication levels. If a dose is missed, contact your veterinarian for guidance; generally, do not double the next dose.
Monitoring for side effects is important. Common side effects include gastrointestinal upset (such as diarrhea or vomiting) and lethargy or weakness due to low blood pressure. More serious but less common side effects might involve kidney issues or significant drops in blood pressure causing pronounced weakness or difficulty standing. If you observe any concerning signs, especially severe lethargy, collapse, or difficulty breathing, contact your veterinarian immediately.
Regular veterinary check-ups are necessary to assess the medication’s effectiveness and manage side effects. Your veterinarian will likely recommend initial blood tests, including kidney values and electrolyte levels, before starting Entresto. These blood tests should be rechecked within 5-14 days after starting the medication and periodically thereafter to monitor kidney function and electrolyte balance. Blood pressure may also be measured periodically, particularly if your dog shows signs of weakness or lethargy.
Be aware of potential drug interactions: Entresto should not be given concurrently with ACE inhibitors (e.g., enalapril, benazepril, or lisinopril), as this can increase the risk of serious side effects like angioedema and kidney problems. A washout period of at least 36 hours is needed when switching between an ACE inhibitor and Entresto. Caution is advised when using Entresto with potassium-sparing diuretics or potassium supplements, as this combination can lead to high potassium levels. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also increase the risk of kidney problems when given with Entresto. Always inform your veterinarian about all medications and supplements your dog is receiving to ensure safe and effective treatment.