| Heart failure with reduced ejection fraction
Entresto vs CaroSpir
Side-by-side clinical, coverage, and cost comparison for heart failure with reduced ejection fraction.Deep comparison between: Entresto vs Carospir with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsCarospir has a higher rate of injection site reactions vs Entresto based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Carospir but not Entresto, including UnitedHealthcare
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Category
Entresto
Carospir
At A Glance
Oral
Twice daily
Neprilysin inhibitor / ARB
Oral
Daily
Aldosterone antagonist
Indications
- Chronic heart failure
- Heart failure with reduced ejection fraction
- Heart failure with reduced ejection fraction
- Hypertensive disease
- Edema
Dosing
Chronic heart failure, Heart failure with reduced ejection fraction Adults: 49/51 mg orally twice daily starting dose; titrate every 2 to 4 weeks to target maintenance dose of 97/103 mg twice daily. Pediatric patients (>=1 year): weight-based dosing titrated every 2 weeks. Reduce starting dose by half for patients not on an ACE inhibitor or ARB, those with severe renal impairment (eGFR <30 mL/min/1.73 m2), or moderate hepatic impairment (Child-Pugh B).
Heart failure with reduced ejection fraction Initiate at 20 mg once daily; may increase to 37.5 mg once daily as clinically indicated; may reduce to 20 mg every other day if hyperkalemia develops; consider initiating at 10 mg once daily in patients with eGFR 30-50 mL/min/1.73m2.
Hypertensive disease Initiate at 20 to 75 mg daily in single or divided doses; titrate at two-week intervals; doses >75 mg/day generally do not provide additional blood pressure reduction.
Edema Initiate in a hospital setting at 75 mg daily in single or divided doses; titrate slowly; administer for at least five days before increasing dose to obtain desired effect.
Contraindications
- Hypersensitivity to any component of ENTRESTO
- History of angioedema related to previous ACE inhibitor or ARB therapy
- Concomitant use of ACE inhibitors, or within 36 hours of switching from or to an ACE inhibitor
- Concomitant use of aliskiren in patients with diabetes
- Hyperkalemia
- Addison's disease
- Concomitant use of eplerenone
Adverse Reactions
Most common (>=5%) Hypotension, hyperkalemia, cough, dizziness, renal failure/acute renal failure
Serious Angioedema, hypotension, impaired renal function, hyperkalemia
Postmarketing Hypersensitivity reactions including rash, pruritus, and anaphylactic reaction
Serious Hyperkalemia, hypotension, worsening renal function, electrolyte and metabolic abnormalities, gynecomastia, impaired neurological function or coma in patients with hepatic impairment and cirrhosis with ascites
Postmarketing Gastric bleeding, ulceration, gastritis, nausea, vomiting, diarrhea, gynecomastia, decreased libido, erectile dysfunction, irregular menses, amenorrhea, postmenopausal bleeding, leukopenia, agranulocytosis, thrombocytopenia, fever, urticaria, anaphylactic reactions, vasculitis, hyponatremia, hypovolemia, leg cramps, lethargy, mental confusion, ataxia, dizziness, headache, renal dysfunction, renal failure, Stevens-Johnson Syndrome, toxic epidermal necrolysis, DRESS, alopecia, pruritus, chloasma, cholestatic/hepatocellular toxicity
Pharmacology
Neprilysin inhibitor / ARB combination; sacubitril (via active metabolite LBQ657) inhibits neprilysin to increase levels of natriuretic peptides, while valsartan selectively blocks the AT1 receptor and inhibits angiotensin II-dependent aldosterone release, producing combined cardiovascular and renal effects in heart failure.
Aldosterone antagonist; spironolactone and its active metabolites competitively bind aldosterone receptors at the sodium-potassium exchange site in the distal convoluted renal tubule, increasing sodium and water excretion while retaining potassium, exerting diuretic and antihypertensive effects.
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Most Common Insurance
Anthem BCBS
Entresto
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Carospir
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (1/12)
UnitedHealthcare
Entresto
- Covered on 4 commercial plans
- PA (3/8) · Step Therapy (0/8) · Qty limit (4/8)
Carospir
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Entresto
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (3/3)
Carospir
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Entresto.
No savings programs available for Carospir.
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Next Steps for Your Patient
EntrestoView full Entresto profile
CarospirView full Carospir profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.