Can you take Entresto and carvedilol together?
Short answer
Medication question
Yes — Entresto (sacubitril/valsartan) and carvedilol are frequently used together in the management of heart failure with reduced ejection fraction under medical supervision. Both medications affect blood pressure and heart rate, so the combination requires careful prescriber oversight and individualized dose titration. Do not combine, stop, or adjust either drug without explicit guidance from your cardiologist or prescriber.
This is a general research summary, not medical advice. A pharmacist can confirm it for your situation.
Key facts
ACC/AHA heart failure guidelines support combination use of ARNIs (Entresto) and beta-blockers (carvedilol) in HFrEF.
Entresto must not be taken within 36 hours of an ACE inhibitor due to risk of serious angioedema.
Additive hypotension is a known risk when combining multiple antihypertensive/heart failure agents.
Here's the nuance
A one-liner rarely tells the whole story. This is the honest detail behind the short answer above.
Entresto (sacubitril/valsartan) is an angiotensin receptor-neprilysin inhibitor (ARNI) approved for chronic heart failure with reduced ejection fraction (HFrEF). Carvedilol is a non-selective beta-blocker with alpha-1 blocking properties, also used in HFrEF. Major heart failure guidelines — including those from the American College of Cardiology and the American Heart Association — support the use of both drug classes together as part of guideline-directed medical therapy for HFrEF.
The combination is clinically logical: Entresto addresses the neurohormonal overactivation from the renin-angiotensin-aldosterone system side, while carvedilol addresses excess sympathetic nervous system activation — both of which drive adverse cardiac remodeling in heart failure. Clinical trials have used both classes together. Real-world practice commonly involves Entresto and carvedilol (or other beta-blockers) prescribed simultaneously.
However, both medications lower blood pressure, and carvedilol also slows heart rate. The combination can cause additive hypotension (low blood pressure) and bradycardia (slow heart rate), especially during dose initiation or uptitration. This is why heart failure pharmacotherapy is titrated slowly and carefully by a cardiologist or heart failure specialist — starting doses are low and increased gradually as tolerated, with blood pressure and heart rate monitoring at each step.
If you are currently taking one of these medications and your prescriber is considering adding the other, expect a gradual titration process with follow-up visits. If you are already on both and experiencing dizziness, lightheadedness, fainting, or a very slow pulse, contact your prescriber promptly — do not stop either medication without guidance, as abrupt discontinuation of a beta-blocker or ARNI can be harmful in heart failure. All dose decisions belong with the prescriber who knows your cardiac function, kidney function, and complete medication list.
The key points
The handful of things that decide the answer — skim these if you only read one section.
Both are standard heart failure medications often used together
ACC/AHA heart failure guidelines support combining ARNIs (Entresto) and beta-blockers (carvedilol) in HFrEF — these are two of the cornerstone drug classes in guideline-directed medical therapy. Their combination is clinically well-established.
Additive blood pressure lowering requires monitoring
Both Entresto and carvedilol lower blood pressure through different mechanisms. Carvedilol also slows heart rate. The combination can cause symptomatic hypotension or bradycardia, particularly when doses are being adjusted. Regular monitoring by your prescriber is essential.
Dose titration must be done slowly and under medical supervision
Heart failure medications are started at low doses and increased gradually. Adding Entresto to an existing beta-blocker regimen (or vice versa) is done incrementally, with blood pressure and heart rate checks at each step. Do not adjust doses on your own.
Do not stop either medication abruptly
Abrupt discontinuation of carvedilol or Entresto in heart failure can cause rebound worsening of cardiac function. If you need to stop either medication — for any reason — this should be done under medical supervision with a tapering plan.
Kidney function monitoring is important with Entresto
The valsartan component of Entresto affects kidney function, particularly in patients with pre-existing kidney disease. Regular renal function monitoring is standard when on Entresto. Your prescriber will factor this into how carvedilol doses are adjusted alongside it.
Please read before acting on this
General information — not medical advice
This page is a general research summary about the medication in question. It does not account for your specific health, other medicines you take, or your dose, and it can go out of date. It is not medical advice, a prescription, or a substitute for professional judgment.
Ask your pharmacist or prescriber before starting, stopping, changing, or continuing any medication — they can check it against your situation in minutes.
Frequently Asked Questions
Yes — in current ACC/AHA heart failure guidelines, Entresto (an ARNI) is preferred over ACE inhibitors for patients with HFrEF who can tolerate it and who are already on an ACE inhibitor or ARB. Entresto has demonstrated greater mortality and hospitalization benefit than enalapril in the PARADIGM-HF trial. Importantly, Entresto must not be taken with an ACE inhibitor — you must wait at least 36 hours after stopping an ACE inhibitor before starting Entresto to avoid angioedema risk. Your cardiologist manages this transition.
Yes — both medications lower blood pressure, and their combination can cause additive hypotension, particularly during dose initiation or uptitration. Symptoms may include dizziness, lightheadedness, or near-fainting when standing up quickly. Your prescriber will monitor blood pressure at each visit and adjust doses accordingly. If you experience significant hypotension symptoms between visits, contact your prescriber before adjusting either medication on your own.
If you miss a dose of either Entresto (taken twice daily) or carvedilol (taken twice daily with meals), take it as soon as you remember — unless it is close to the time of your next scheduled dose, in which case skip the missed dose and resume the regular schedule. Do not double-dose to make up for a miss. Both medications work continuously to support cardiac function, so consistent dosing matters. If you frequently miss doses, talk to your prescriber about strategies to improve adherence.
Other beta-blockers with clinical evidence in HFrEF — specifically metoprolol succinate (extended-release) and bisoprolol — are acceptable alternatives to carvedilol in some patients. The choice between beta-blockers depends on tolerability, comorbidities (e.g., carvedilol's alpha-blocking activity may be preferred in some patients, while others tolerate more selective beta-blockers better), and prescriber preference. This is a clinical decision made by your cardiologist, not one to make by switching on your own.
Your cardiologist will monitor your response through symptom assessment (improved exercise tolerance, less shortness of breath, less fluid retention), echocardiography (looking for improvements in ejection fraction), and lab work (kidney function, electrolytes, BNP or NT-proBNP levels). Both medications need several weeks to months at the target dose to show their full benefit. Regular cardiology follow-up is essential — do not adjust the regimen based on short-term symptom fluctuations without consulting your prescriber.
Reviewed by
Dr. Chet TharpeMD
Last reviewed July 2026
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This content is for general informational purposes only. It is not medical advice, a prescription, or a substitute for professional judgment, and it does not account for your health, other medications, or dose. Always ask your pharmacist or prescriber before starting, stopping, or changing any medication.
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