A fixed combination of 2 drugs in one pill.
Sold as Entresto.
A combination is graded by its riskiest ingredient: each part of the score is the lowest of the ingredients' scores. This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.
Each ingredient has its own full page with the FDA label, side-effect reports, recalls, evidence, and payments. Open them for the detail behind this grade.
Score breakdown (63/100)
Safety ×35%
C
Evidence ×25%
C
Regulatory ×15%
A
Money & lawsuits ×15%
F
Options ×10%
F
Safety: 70
Graded by its riskiest ingredient, sacubitril (70)
Carries an FDA boxed warning, the strongest warning the FDA issues (-30)
Death share in reports is near or below the FAERS average (1.0x)
Evidence: 63
Graded by its riskiest ingredient, valsartan (63)
615 randomized trials and 100 systematic reviews/meta-analyses indexed in PubMed
On the WHO Model List of Essential Medicines (shown for context; no score effect)
No Cochrane review found (-5)
Only 31% of completed registered trials posted results (-15)
'Drug ineffective' is the single most-reported item about this drug in FAERS (-5)
Regulatory history: 93
Graded by its riskiest ingredient, valsartan (93)
Recalls since 2016: 0 Class I, 17 Class II, 3 Class III across 24 generic makers (-7)
Money & lawsuits: 30
Graded by its riskiest ingredient, sacubitril (60)
Pharma paid doctors $0 tied to this drug last year: negligible
Named in 1 active federal multidistrict litigation(s) (-40)
For the combination product itself:
Pharma paid doctors $1,132,925 tied to this drug last year (-30)
Named in 1 active federal multidistrict litigation(s) (-40)
Options: 40
Graded by its riskiest ingredient, sacubitril (40)
No generic version approved: brand-only pricing (-30)
No same-class alternatives found: little leverage to switch (-30)
Money and lawsuits
In 2024, drug companies reported $1,132,925 in payments to US physicians and hospitals tied to this combination's brands across 58,085 transactions (Entresto $1,132,925).
The ingredients' own payments and lawsuits are on their pages and already count toward this grade.
Who takes it and what it costs
795,388Medicare Part D patients (2024)
3,898,977prescriptions filled
$1,031average cost per fill
$4,020Mtotal Medicare spend
Product
Fills
$/fill
Entresto
3,898,804
$1,031
Entresto Sprinkle
173
$837
Questions to ask your prescriber
This is a fixed combination of sacubitril and valsartan. Why both together, instead of only the one I need?
This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?
The most-reported problems in FDA's adverse event data are cardiac failure, hypotension, acute kidney injury, oedema peripheral. How would we recognize and handle those?
There is no generic. Is there an older generic in the same class that works as well for my situation?
This drug is in active federal litigation. What is the claim, and does it affect my risk?
What result are we expecting, by when, and what is the plan if it does not happen?
If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)
The most-reported problems in FDA's adverse event data are fatigue, dyspnoea, diarrhoea. How would we recognize and handle those?
Why this one over azilsartan medoxomil, candesartan, eprosartan? What would make you pick one of those instead?