Side Effects of Jardiance (Empagliflozin)
The most common side effects of Jardiance (empagliflozin) include genital mycotic infections, urinary tract infections, and increased urination, while serious but less common side effects include ketoacidosis, hypotension, and acute kidney injury. 1, 2
Common Side Effects
- Genital mycotic infections (yeast infections) are particularly common, especially in females, and can be managed with proper genital hygiene 2, 3
- Urinary tract infections may occur more frequently with SGLT2 inhibitor therapy, though serious UTIs are relatively uncommon 1, 2
- Increased urination due to the osmotic diuretic effect of the medication 4
- Volume depletion/hypotension is particularly concerning in elderly patients or those taking diuretics 3, 5
- Increased cholesterol levels may occur, particularly LDL cholesterol 1, 6
Serious but Less Common Side Effects
- Diabetic ketoacidosis (DKA) is a rare but serious side effect that can occur even with normal blood glucose levels (euglycemic DKA) 1, 3
- Acute kidney injury has been reported, particularly in situations of reduced fluid intake or increased fluid losses 1
- Serious urinary tract infections including pyelonephritis and urosepsis requiring hospitalization have been reported, though clinical trials show no significant difference in rates compared to placebo 2, 7
- Necrotizing fasciitis of the perineum (Fournier's gangrene) has been reported in rare cases, though causal relationship is unclear 2
Special Population Considerations
- Renal impairment: Empagliflozin has reduced glycemic efficacy when eGFR <45 mL/min/1.73m² 3, 5
- Elderly patients may be at higher risk for volume depletion and hypotension 5, 7
- Patients on diuretics should be monitored carefully for signs of hypotension 5, 1
- Surgical patients should discontinue empagliflozin at least 3 days before scheduled surgery to reduce risk of ketoacidosis 5
Monitoring Recommendations
- Monitor for signs of ketoacidosis (nausea, vomiting, abdominal pain, tiredness, and labored breathing), particularly during illness, reduced oral intake, or fluid losses 1, 3
- Watch for symptoms of genital mycotic infections (rash, redness, itching in genital area) 1, 2
- Monitor for signs of urinary tract infections (burning sensation when urinating, frequent urination, pelvic pain, blood in urine) 1, 2
- Be vigilant for symptoms of volume depletion (dizziness, lightheadedness, weakness, fainting) especially when starting therapy 5, 1
- Regular monitoring of renal function is recommended, particularly in patients at risk for kidney problems 1, 7
Cardiovascular and Renal Effects
- While not side effects, it's worth noting that empagliflozin has shown cardiovascular benefits with reduction in cardiovascular death and hospitalization for heart failure 2, 8
- Empagliflozin has demonstrated renal protective effects by slowing eGFR decline in patients with diabetic kidney disease 5, 7
Practical Considerations
- Side effects like genital mycotic infections are generally manageable and rarely lead to discontinuation of therapy 2, 7
- The risk of hypoglycemia is low when used as monotherapy but increases when combined with insulin or sulfonylureas 1, 9
- Most side effects occur early in treatment and tend to diminish over time 7
- The benefits of empagliflozin in reducing cardiovascular and renal outcomes often outweigh the risks of side effects in appropriate patients 2, 8