Jardiance Can Be Continued in Balanitis with Concurrent Antifungal Treatment
Jardiance (empagliflozin) does not need to be discontinued in patients with active balanitis; instead, treat the balanitis with topical antifungal agents while continuing the SGLT2 inhibitor. The FDA label explicitly states to "monitor and treat as appropriate" for genital mycotic infections, not to discontinue therapy 1.
Clinical Approach to Balanitis in SGLT2 Inhibitor Users
Immediate Management
- Continue Jardiance while treating the balanitis
- Prescribe topical antifungal cream (clotrimazole, miconazole, or similar) for 7-14 days 2
- For symptomatic relief, men with candidal balanitis benefit from topical antifungal agents 2
Risk Stratification
The 2018 ACC Expert Consensus notes that genital mycotic infections with SGLT2 inhibitors are not usually serious, tend to resolve with a brief course of antifungal agents, and rarely recur 3. The 2022 guidelines confirm genital mycotic infections occur in approximately 6% of SGLT2 inhibitor users versus 1% with placebo, with higher risk in women than men 4.
When to Consider Discontinuation
Discontinue Jardiance only if:
- Necrotizing fasciitis (Fournier's gangrene) is suspected—look for pain/tenderness, erythema, or swelling in the genital/perineal area with fever or malaise 1
- Recurrent infections despite appropriate antifungal therapy and hygiene measures
- Patient develops severe or complicated infection requiring hospitalization
Prevention Strategies
The 2022 Canadian guidelines emphasize that genital mycotic infection risk can be reduced with appropriate genital hygiene strategies 5. Counsel patients on:
- Daily hygiene measures
- Early recognition of symptoms
- Prompt treatment initiation
Important Caveats
Risk factors for recurrent genital infections include:
- History of chronic or recurrent genital mycotic infections 1
- Uncircumcised men 5
- Previous genital mycotic infection 5
The 2022 diabetes management consensus confirms that most genital mycotic infections are easily treated and do not require drug discontinuation 4. Recent research from 2025-2026 shows that while empagliflozin carries a slightly higher relative risk of genital tract infections compared to dapagliflozin (RR 1.14), the absolute risk difference remains small at approximately 2% 6, 7.
Clinical Bottom Line
The cardiovascular and renal benefits of Jardiance—including 38% reduction in cardiovascular death and 32% reduction in all-cause mortality 3, 8—far outweigh the manageable risk of balanitis. Treat the infection, maintain the drug, and counsel on hygiene. Only discontinue if severe complications develop or infections become recurrent despite optimal management.