Can Jardiance (Empagliflozin) cause yeast infections?

Can Jardiance Cause Yeast Infections?

Yes, Jardiance (empagliflozin) significantly increases the risk of genital yeast infections, occurring in approximately 4% of patients compared to 1% with placebo, and this is a well-documented adverse effect in the FDA drug label. 1

Mechanism and Incidence

Jardiance causes increased urinary glucose excretion through SGLT2 inhibition, which creates a glucose-rich environment in the genitourinary tract that promotes yeast growth 2. The FDA label specifically warns about:

• Vaginal yeast infections (vulvovaginal candidiasis) in women: 4.1-3.7% with Jardiance vs 0.9% with placebo 1
• Penile yeast infections (balanitis/balanoposthitis) in men: particularly in uncircumcised males 1
• Female patients are affected more frequently than males 1

Risk Factors to Identify

The highest-risk patients include 3, 4:

• Women (4-fold increased risk compared to men) 4
• Patients with prior history of genital fungal infections (2.4-fold increased risk) 4
• Uncircumcised men with chronic/recurrent infections 1
• Age ≤55 years in women 5

Notably, glycemic control level, diabetes duration, BMI, renal function, and ethnicity were not predictive of infection risk 4.

Clinical Management Algorithm

For Mild to Moderate Infections:

Continue Jardiance during treatment 3. The CDC and FDA recommend 6, 1:

• First-line for women: Topical antifungals (clotrimazole, miconazole, terconazole) for 3-7 days OR single-dose oral fluconazole 150mg 6
• First-line for men: Topical antifungal agents applied directly to affected areas 6
• Most infections resolve without drug interruption; discontinuation due to genital infection occurred in only 0.2% of patients 1

For Recurrent Infections:

• Initial therapy: 7-14 days of treatment 6
• Maintenance therapy: Fluconazole 150mg weekly for 6 months 6
• Consider temporary discontinuation of Jardiance if infections are severe or frequently recurrent 3

For Severe Infections:

• Discontinue Jardiance immediately for severe infections or Fournier's gangrene 3
• Provide urgent medical attention with appropriate surgical and antibiotic management 3
• Consider permanent discontinuation in cases of severe or recurrent infections 3

Patient Counseling Points

The FDA label mandates counseling patients about 1:

• Women: Watch for vaginal odor, white/yellowish discharge (cottage cheese-like), and vaginal itching 1
• Men: Watch for redness, itching, swelling of the penis, penile rash, foul-smelling discharge, and pain around the penis 1
• Uncircumcised men: May develop swelling making it difficult to retract foreskin 1
• Advise patients they can use over-the-counter antifungal medications 1
• Seek medical attention if symptoms persist after OTC treatment 6, 1

Critical Pitfalls to Avoid

• Do not routinely treat sexual partners unless they are symptomatic, though consider treatment for women with recurrent infections 6
• Do not use echinocandins or non-fluconazole azoles for urinary candidiasis as they have minimal urinary excretion 7
• Do not confuse symptoms with more serious conditions like Fournier's gangrene, which requires immediate intervention 3
• Do not discontinue Jardiance prematurely for mild infections that respond to standard antifungal therapy, as the cardiovascular and renal benefits generally outweigh infection risks 3

Special Populations

Immunocompromised patients (including kidney transplant recipients) require more careful monitoring and may be at higher risk 3. The diuretic effect and cardiovascular benefits of empagliflozin appear unrelated to its glucose-lowering effect, making continuation important in appropriate patients despite manageable genital infections 8, 2.