Yes, Farxiga (dapagliflozin) does cause both urinary tract infections and genital yeast infections, though the risk varies by infection type.
Farxiga increases the risk of genital yeast infections significantly (3-4 fold increase) and may increase urinary tract infections, particularly at higher doses. 1
Genital Yeast Infections (Mycotic Infections)
The FDA label explicitly lists vaginal yeast infections and yeast infections of the penis as among the most common side effects of Farxiga 1. The mechanism is straightforward: by causing glucose to spill into the urine (glucosuria), SGLT2 inhibitors like dapagliflozin create a glucose-rich environment in the genital area that promotes fungal growth 1.
Key evidence:
- Genital infections occur at a rate of 2-10% across SGLT2 inhibitor therapies 2
- Meta-analysis data shows a 3.37-fold increased risk versus placebo and 3.89-fold versus active comparators 3
- A 2023 meta-analysis found an 8.21-fold increased risk of genital infection with dapagliflozin versus placebo 4
- Most genital infections are mild and treatable; serious infections are rare 5
Risk factors for genital infections include:
- Prior history of genital mycotic infections (these patients are more likely to develop recurrent infections) 1
- Uncontrolled hyperglycemia
- Uncircumcised males
- Older age 2
Urinary Tract Infections (UTIs)
The UTI risk is more nuanced and dose-dependent. The FDA warns about serious urinary tract infections including urosepsis and pyelonephritis requiring hospitalization 1. However, the overall UTI risk varies by dose.
Key evidence:
- Guidelines list UTIs as an adverse effect to monitor 6
- The large DECLARE-TIMI 58 trial (17,160 patients, 4.2 years follow-up) found UTIs were balanced between dapagliflozin and placebo groups overall 5
- However, drug-specific analysis shows dapagliflozin 10 mg daily was associated with significantly increased UTI risk (RR 1.33) compared to placebo, while lower doses were not 3
- A 2025 comparative study found urination frequency was higher with 10 mg (
55%) versus 5 mg (25%), and urgency was ~48% versus ~20% 7 - A 2025 case report documented emphysematous pyelonephritis (a severe, life-threatening kidney infection) associated with dapagliflozin use 8
Risk factors for UTIs include:
- Female sex (UTIs are more common in women than men) 2
- Uncontrolled hyperglycemia
- Prior history of genitourinary infections
- Older age 2
Clinical Management Algorithm
Before starting Farxiga:
- Screen for history of recurrent genital or urinary infections
- Assess current glycemic control (poor control increases infection risk)
- In males, document circumcision status
- Educate patients about infection symptoms
During treatment:
- Monitor for burning with urination, urgency, frequency, pelvic pain, or blood in urine (UTI symptoms) 1
- Monitor for genital itching, discharge, or discomfort (yeast infection symptoms)
- If UTI symptoms develop: Evaluate and treat promptly; serious infections like urosepsis and pyelonephritis can occur 1
- If genital infections develop: Most are mild and respond to standard antifungal therapy 1
- Consider dose reduction from 10 mg to 5 mg if recurrent UTIs occur, as lower doses have lower UTI risk 3, 7
Important caveat: Despite these infection risks, the cardiovascular and renal benefits of dapagliflozin (reduced heart failure hospitalization, CV death, and kidney disease progression) generally outweigh the infection risks in appropriate patients 6, 2, 5. The infections are typically mild and treatable, while the CV/renal benefits reduce morbidity and mortality 4, 5, 9.
Do not use Farxiga in patients with:
- Active or recurrent severe genitourinary infections
- Immunocompromised states where infection risk is unacceptable
- Inability to maintain adequate hygiene 9
The key is patient selection and education: inform patients these infections can occur, teach them to recognize symptoms early, and treat promptly when they develop.