From the Guidelines
Jardiance (empagliflozin) can predispose patients to urinary tract infections (UTIs), as it increases glucose excretion in the urine, creating a more favorable environment for bacterial growth in the urinary tract. According to the most recent and highest quality study available, which is the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1, SGLT2 inhibitors, including Jardiance, have been associated with an increased risk of genital mycotic infections, which can be a complication of UTIs.
The mechanism behind this increased risk is related to the medication's mechanism of action, which increases glucose excretion in the urine, creating a more favorable environment for bacterial growth in the urinary tract. Patients taking Jardiance should be vigilant about UTI symptoms, including burning during urination, increased urinary frequency, cloudy urine, or pelvic pain. Good hygiene practices, adequate hydration, and prompt reporting of symptoms to healthcare providers are important preventive measures.
While the risk of UTIs exists, it should be balanced against the medication's significant benefits for glycemic control and cardiovascular/renal protection in appropriate patients with type 2 diabetes. The 2018 study by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1 also highlights the importance of considering the benefits and risks of SGLT2 inhibitors, including Jardiance, in patients with type 2 diabetes.
In terms of prevention and treatment of UTIs, the 2018 study on treatment and prevention of recurrent lower urinary tract infections in women 1 suggests that daily hygienic measures, adequate hydration, and prompt reporting of symptoms to healthcare providers are important preventive measures. Additionally, the study highlights the importance of considering the use of cranberry products, probiotics, and other alternative therapies in preventing UTIs, although the evidence for these therapies is not yet conclusive.
Overall, the benefits of Jardiance in patients with type 2 diabetes outweigh the risks of UTIs, but patients should be aware of the potential risk and take preventive measures to minimize it. Healthcare providers should also be vigilant in monitoring patients for UTI symptoms and adjusting treatment as needed to minimize the risk of complications.
From the FDA Drug Label
In the pool of five placebo-controlled clinical trials, the incidence of urinary tract infections (e.g., urinary tract infection, asymptomatic bacteriuria, and cystitis) was increased in patients treated with JARDIANCE compared to placebo (see Table 1). Patients with a history of chronic or recurrent urinary tract infections were more likely to experience a urinary tract infection. The rate of treatment discontinuation due to urinary tract infections was 0.1%, 0.2%, and 0. 1% for placebo, JARDIANCE 10 mg, and JARDIANCE 25 mg, respectively. Urinary tract infections occurred more frequently in female patients. The incidence of urinary tract infections in female patients randomized to placebo, JARDIANCE 10 mg, and JARDIANCE 25 mg was 16.6%, 18.4%, and 17. 0%, respectively. The incidence of urinary tract infections in male patients randomized to placebo, JARDIANCE 10 mg, and JARDIANCE 25 mg was 3.2%, 3.6%, and 4.1%, respectively [see Warnings and Precautions (5.4) and Use in Specific Populations (8. 5)].
Yes, Jardiance may predispose to UTI, as the incidence of urinary tract infections was increased in patients treated with JARDIANCE compared to placebo, especially in female patients 2.
From the Research
Jardiance and UTI Risk
- The relationship between Jardiance (empagliflozin) and the risk of urinary tract infections (UTIs) has been investigated in several studies 3, 4, 5, 6, 7.
- A real-world observational study found that patients treated with SGLT2 inhibitors, including empagliflozin, had a higher risk of UTIs compared to those treated with non-SGLT2 inhibitors 3.
- Another study found that the incidence rates of UTIs were not different between dapagliflozin and empagliflozin treatment, but patients treated with SGLT2 inhibitors had a 3.70 higher risk of UTI compared with those treated with non-SGLT2 inhibitors 3.
- A network meta-analysis found that there was no statistically significant difference between SGLT2 inhibitors, including empagliflozin, in terms of the relative frequency of UTIs 4.
- A retrospective chart review found that there was no statistically significant difference in UTI rates when comparing catheters alone to concurrent catheter and empagliflozin-use 5.
- A meta-analysis of randomized controlled trials found that empagliflozin was associated with a higher risk of genital infections, but only dapagliflozin 10 mg led to significantly more UTIs than placebo 6.
- A safety evaluation of empagliflozin found that the evidence for its safety is robust, with a low risk of hypoglycemia and absence of weight gain, but did not specifically address the risk of UTIs 7.
Risk Factors for UTIs
- The studies identified several risk factors for UTIs, including female gender, older age, and occupation 3.
- The use of catheters was also identified as a potential risk factor for UTIs, but the study found that there was no statistically significant difference in UTI rates when comparing catheters alone to concurrent catheter and empagliflozin-use 5.
- The meta-analysis found that the increased risk of UTIs and genital infections seemed to have a dose-response relationship for dapagliflozin only 6.