From the Guidelines
Jardiance (empagliflozin) can increase the risk of urinary tract infections (UTIs). This medication works by causing the kidneys to remove excess sugar through the urine, which creates an environment where bacteria may thrive more easily. According to the most recent evidence from 1, SGLT2 inhibitors, including empagliflozin, have been associated with an increased risk of genital mycotic infections, which can be mitigated with daily hygienic measures.
Some key points to consider:
- Clinical studies have shown that approximately 6% of participants assigned to an SGLT2i, such as empagliflozin, develop genital mycotic infections, compared with 1% of those assigned to placebo 1.
- Women are generally at higher risk than men for these infections while using the medication.
- Patients taking Jardiance should watch for UTI symptoms including burning during urination, increased urinary frequency, cloudy urine, or pelvic pain.
- To reduce the risk, it's essential to stay well-hydrated, practice good hygiene, and urinate regularly.
- If you experience symptoms of a UTI while taking Jardiance, contact your healthcare provider promptly, but don't stop taking the medication without medical advice, as it provides important benefits for managing diabetes and reducing cardiovascular risk.
It's also important to note that the benefits of empagliflozin in reducing cardiovascular risk and kidney disease progression outweigh the potential risks of UTIs, as demonstrated in studies such as the EMPA-REG OUTCOME trial 1. Therefore, patients should not stop taking the medication without consulting their healthcare provider.
From the FDA Drug Label
ADVERSE REACTIONS Most common adverse reactions (6.1): Adults (≥ 18 years) (>1%) are: headache, diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth. Pediatrics (1 to 17 years) (>2%) are: headache, diarrhea, abdominal pain, nausea, and somnolence.
The FDA drug label does not answer the question.
From the Research
Jardiance (Empagliflozin) and Urinary Tract Infections (UTIs)
- Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to increase the risk of urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (T2DM) 2, 3.
- A study found that patients treated with SGLT2 inhibitors, including empagliflozin, had a 3.70 higher risk of UTI compared to those treated with non-SGLT2 inhibitors 3.
- Another study found that the incidence of UTIs was not significantly different between patients using catheters alone and those using catheters with empagliflozin 4.
- The mechanism of action of SGLT2 inhibitors, which increases glycosuria, may contribute to the development of UTIs 5, 6.
- Risk factors for UTIs in patients using empagliflozin include female gender, older age, and occupation 3.
Empagliflozin and UTI Incidence
- A real-world observational study found that the overall incidence rate of UTI was 33.49% in the SGLT2 inhibitor group, including empagliflozin, and 11.72% in the non-SGLT2 inhibitor group 3.
- The incidence rates of UTI were not significantly different between dapagliflozin and empagliflozin treatment 3.
- A study found that the use of empagliflozin was associated with a slightly increased risk of UTI, but the infections were generally mild to moderate and clinically manageable 2.
Mechanism and Pathophysiology
- The pathophysiology of UTIs is associated with multiple anatomical and physiological dysfunctions that predispose infection, as well as iatrogenic factors, including the use of certain medications, such as SGLT2 inhibitors 6.
- The mechanism of action of SGLT2 inhibitors, which increases glycosuria, may contribute to the development of UTIs by promoting bacterial growth 5, 6.