Does Farxiga Cause UTIs?
Yes, Farxiga (dapagliflozin) does cause an increased risk of urinary tract infections, though the absolute increase is modest and most infections are mild to moderate and easily treatable. 1
Mechanism and Risk Profile
Dapagliflozin is an SGLT2 inhibitor that works by blocking glucose reabsorption in the kidney, leading to increased urinary glucose excretion (glucosuria). 1 This creates a glucose-rich urinary environment that theoretically promotes bacterial growth, though the relationship between glucosuria levels and UTI incidence is not strictly dose-dependent. 2
Evidence from Clinical Trials and FDA Labeling
Incidence Rates
- Pooled trial data (n=3,152 dapagliflozin patients vs 1,393 placebo patients) showed UTI rates of 3.6% (2.5mg), 5.7% (5mg), and 4.3% (10mg) for dapagliflozin compared to 3.7% for placebo. 2
- Meta-analysis demonstrated a statistically significant increased risk (RR: 1.33; 95% CI: 1.10-1.60; p=0.004). 3
- Real-world prevalence in diabetic patients on dapagliflozin was 5.3%, with women more affected (76.2%) than men. 4
Severity and Clinical Management
- Most UTIs were mild to moderate and responded to standard antimicrobial treatment. 2, 5
- Discontinuation due to UTI was rare: only 0.3% of dapagliflozin-treated patients versus 0.1% of placebo patients. 2
- The FDA label specifically warns about serious urinary tract infections including urosepsis and pyelonephritis requiring hospitalization, though these are uncommon. 1
High-Risk Populations Requiring Caution
The 2025 American Diabetes Association guidelines specifically advise caution in certain populations: 6
- Patients with recurrent or severe UTIs should have SGLT2 inhibitors used cautiously or avoided
- Older adults are at greater risk for complications
- Patients with urinary incontinence should be queried about symptoms before and after initiation, as SGLT2 inhibitors increase urine volume 6
- Males with bladder outlet obstruction are at particularly high risk, as demonstrated by case reports of E. coli septicemia in patients with incomplete bladder emptying and urinary stasis 7
The European Association of Urology guidelines note that diabetes itself is a risk factor for catheter-associated UTIs and complicated UTIs. 6
Clinical Recommendations
Before Initiating Dapagliflozin
- Assess for history of recurrent UTIs (≥3 episodes/year or 2 in last 6 months) 6
- In males, particularly older men, consider evaluating for bladder outlet obstruction or elevated post-void residual volumes 7
- Counsel patients about UTI symptoms and the need for prompt treatment 1
During Treatment
- Monitor for UTI symptoms: dysuria, frequency, urgency, suprapubic pain, fever 1
- Evaluate and treat UTIs promptly if they occur 1
- Women are at higher risk (76.2% of cases) and should be counseled accordingly 4
- Most infections do not require drug discontinuation and respond to standard antibiotics 2, 4
When to Avoid or Discontinue
- Active serious UTI (urosepsis, pyelonephritis) 1
- Recurrent severe UTIs despite treatment 6
- Male patients with documented bladder outlet obstruction and urinary stasis 7
Balancing Risk and Benefit
Despite the increased UTI risk, dapagliflozin provides significant cardiovascular and renal benefits in appropriate patients, with stratified analyses showing older adults may have similar or greater benefits than younger patients. 6 The UTI risk should be weighed against these benefits, particularly in patients with heart failure or chronic kidney disease where SGLT2 inhibitors have demonstrated mortality reduction.
The key is appropriate patient selection and vigilant monitoring rather than blanket avoidance of this medication class. 6