Is Itching a Side Effect of Entresto? Understanding the Risks

October 8, 2025 •

4 min read

According to the Food and Drug Administration (FDA) and other medical sources, mild itching was not specifically reported as a direct side effect in initial clinical trials for the heart failure medication Entresto. However, reports of itching and rash have surfaced since the drug became available, and more importantly, it is a significant symptom of a potentially severe allergic reaction known as angioedema.

Quick Summary

Itching associated with Entresto can be a sign of an allergic reaction, a rare but serious adverse effect, or a symptom of potential kidney problems. Immediate medical evaluation is necessary for severe symptoms like swelling or breathing difficulties. Consulting a healthcare provider is vital for managing any new symptoms while taking this medication.

Key Points

Not a Direct Side Effect: Mild itching was not a common symptom reported in clinical trials for Entresto.
Allergic Reaction: Itching can be a symptom of a mild allergic reaction, often accompanied by a rash or flushing.
Angioedema Risk: Itching is a key symptom of angioedema, a rare but severe allergic reaction that causes swelling and can be life-threatening.
Kidney Problem Indicator: Itchy skin can also be a symptom of underlying kidney problems, which can be a side effect of Entresto.
Seek Emergency Care: If itching is accompanied by swelling of the face, lips, tongue, or difficulty breathing, call 911 immediately.
Consult Your Doctor: Always report new or persistent itching to your healthcare provider to determine the cause and necessary actions.

Entresto (sacubitril/valsartan) is a prescription medication widely used to treat chronic heart failure, but like any drug, it comes with a list of potential side effects. While common side effects such as low blood pressure, dizziness, and cough are well-documented, the link between Entresto and itching is more complex. Rather than being a typical side effect, itching is a notable symptom that could indicate a more serious underlying issue, such as a hypersensitivity reaction or a problem with kidney function. It's crucial for patients to understand the different reasons they might be experiencing itchy skin and when to seek medical attention.

Allergic Reactions and Angioedema

One of the most concerning causes of itching while on Entresto is an allergic reaction. This can range from a mild rash to a life-threatening condition called angioedema. Angioedema is a rare but severe allergic reaction involving rapid swelling of the deep layers of the skin and tissue. This reaction is more likely to affect Black patients and those with a prior history of angioedema.

Symptoms of allergic reaction

Mild allergic reaction: Itching, skin rash, or flushing. These symptoms should still be reported to a doctor, who may suggest a topical cream or oral antihistamine.
Severe allergic reaction (Angioedema): Itching accompanied by swelling of the face, lips, tongue, or throat. This can lead to difficulty breathing or swallowing and is considered a medical emergency.

Immediate action required for angioedema

If any signs of angioedema appear, particularly swelling around the face or difficulty breathing, you must:

Stop taking Entresto immediately.
Call emergency services (911 in the US) or go to the nearest emergency room.
Do not take Entresto again without your doctor's explicit instruction.

Kidney Problems and Itchy Skin

Entresto can sometimes affect kidney function, and worsening kidney problems can cause various symptoms, including itchy skin. The kidneys help filter waste from the blood, and if they are not working correctly, waste products can build up and lead to an accumulation of toxins under the skin. This can cause a symptom known as uremic pruritus, or kidney-related itching.

Comparison of Itching Causes with Entresto


Feature	Mild Allergic Reaction	Severe Allergic Reaction (Angioedema)	Kidney Problems
Symptom Type	Itching, rash, flushing	Itching, tingling, swelling (face, throat), difficulty breathing	Itchy skin, potentially widespread
Onset	Can occur anytime after starting medication	Can occur anytime, including after a dose increase	Develops gradually as kidney function declines
Associated Symptoms	None (localized)	Swelling, difficulty breathing/swallowing	Swelling (feet, ankles), fatigue, decreased urine output
Action Required	Contact healthcare provider	Emergency medical help (Call 911)	Contact healthcare provider for evaluation
Re-administration of Entresto?	Possibly, depending on provider's judgment	Never re-administer	Possibly, with dosage adjustment under a doctor's care

When to Seek Medical Attention

Understanding the nuance between different types of itching is key to managing your health effectively while on Entresto. While a mild, temporary itch might not be a major concern, any new or worsening itching should always be discussed with a healthcare provider. The critical distinction lies in the presence of other, more severe symptoms, particularly swelling of the face, throat, or tongue, which are hallmarks of angioedema and require immediate emergency care.

Steps to take if you experience itching

Monitor your symptoms: Note if the itching is isolated or if it's accompanied by a rash, swelling, or difficulty breathing.
Contact your doctor for mild itching: If the itching is mild and localized, call your healthcare provider to report the symptom. They can help determine the cause and appropriate next steps.
Seek emergency care for severe symptoms: If you have any swelling of the face, lips, or tongue, or experience difficulty breathing, call 911 immediately. This is a life-threatening emergency.
Do not restart Entresto: If a doctor confirms you had angioedema, you should not take Entresto again.

Conclusion

In summary, while itching is not a listed common side effect of Entresto, its occurrence should not be dismissed. It can be a red flag for a serious allergic reaction, especially angioedema, or signal underlying kidney issues that require medical attention. Being vigilant about monitoring symptoms, understanding the difference between mild and severe reactions, and knowing when to seek emergency help is critical for anyone taking Entresto. Always prioritize communication with your healthcare provider to ensure your safety and the best possible outcome for your heart health. For more general information on medication side effects, please consult reliable medical resources such as Healthline's detailed overview on Entresto's side effects.

Frequently Asked Questions

No, mild itching is not considered a normal or common side effect when starting Entresto. While it may not be a major concern, it could still signal a mild allergic reaction and should be discussed with your doctor.

Angioedema is a rare but serious allergic reaction that can cause swelling of the face, lips, tongue, or throat, which is often accompanied by itching or tingling. Entresto can cause angioedema, and it is a life-threatening emergency requiring immediate medical attention.

For mild itching, a doctor may recommend an oral antihistamine, but you should always consult your healthcare provider first. If the itching is due to a more serious issue like angioedema or kidney problems, a simple antihistamine will not be enough to manage the condition.

Entresto can sometimes affect kidney function, and if kidney function declines, waste products can build up in the body. This build-up can lead to widespread itchy skin, a condition known as uremic pruritus.

Patients who are Black and those with a prior history of angioedema (even from another medication like an ACE inhibitor) have a higher risk of developing angioedema when taking Entresto.

If you develop an itchy rash, you should contact your doctor right away. While it may be a mild allergic reaction, it is best to be evaluated by a professional to ensure it is not a precursor to a more serious reaction.

Yes, but there is an increased risk of angioedema if not managed correctly. There is a required 36-hour "washout period" between stopping an ACE inhibitor and starting Entresto to minimize this risk.