Does Jardiance Cause Increased Urination?
Yes, Jardiance (empagliflozin) definitively causes increased urination through its mechanism as an SGLT2 inhibitor, which promotes both osmotic diuresis from urinary glucose excretion and natriuresis. 1, 2
Mechanism of Action
Jardiance increases urination through two primary pathways:
Osmotic diuresis: By inhibiting SGLT2 in the renal proximal tubules, empagliflozin prevents glucose reabsorption and increases urinary glucose excretion (averaging 64-78 grams per day), which draws water into the urine 2
Natriuretic effect: The drug causes sodium excretion alongside glucose, contributing to additional fluid loss 1
Quantified urine volume increase: In clinical studies, mean 24-hour urine volume increased by 341 mL on Day 1 and remained elevated at 135 mL on Day 5 of treatment with empagliflozin 25 mg 2
Clinical Incidence
The frequency of increased urination is well-documented in clinical trials:
Polyuria, pollakiuria, and nocturia occurred in 3.4% of patients on Jardiance 10 mg and 3.2% on 25 mg, compared to only 1.0% on placebo 2
Nocturia specifically was reported in 0.3% (10 mg) and 0.8% (25 mg) of patients versus 0.4% on placebo 2
The diuretic effect is most pronounced when blood glucose is elevated and diminishes as glucose normalizes 1
Important Clinical Considerations
Volume Depletion Risk
Patients at high risk for volume depletion require careful monitoring 3, 1, 2:
- Elderly patients 3
- Those on concurrent diuretic therapy 1
- Patients with low blood pressure 1
- Those on low sodium diets 1
- Patients with kidney problems 1
Volume depletion-related adverse reactions (hypotension, orthostatic hypotension, dehydration, syncope) occurred in 0.5% of patients on Jardiance 10 mg and 0.3% on 25 mg versus 0.3% on placebo 2
Patient Counseling
Advise patients to watch for signs of volume depletion 1:
- Orthostatic lightheadedness
- Dizziness
- Feeling faint, especially when standing up
Drug Interactions
Empagliflozin has potentially additive natriuretic effects when combined with loop diuretics, requiring patient awareness of this interaction 1
Do not discontinue or reduce concurrent diuretic therapy preemptively when initiating empagliflozin, as this is usually unnecessary 1
Additional Urinary Effects
Beyond increased frequency, SGLT2 inhibitors carry other urinary considerations:
Urinary tract infections occur more frequently (9.3% with 10 mg, 7.6% with 25 mg versus 7.6% placebo), with caution needed in patients with recurrent or severe UTIs 3, 2
Genital mycotic infections are more common, especially in women (5.4% with 10 mg, 6.4% with 25 mg versus 1.5% placebo) 3, 2
Urinary incontinence symptoms should be queried before and after SGLT2 inhibitor initiation, as increased urine volume may worsen pre-existing incontinence 3
Blood Pressure Effects
The diuretic and natriuretic effects contribute to blood pressure reduction of approximately 3-5 mmHg systolic and 2 mmHg diastolic 1, 4
Common Pitfall to Avoid
Do not assume increased urination is pathological or a reason to discontinue therapy. This is an expected pharmacodynamic effect that typically stabilizes after the first few days of treatment and is part of the drug's therapeutic mechanism 2, 4. However, monitor for excessive volume depletion, particularly in vulnerable populations 3, 1, 2.