Holding Jardiance (Empagliflozin) for UTI
You do not need to routinely hold Jardiance (empagliflozin) for an uncomplicated UTI, but should temporarily discontinue it if the patient develops signs of complicated infection, sepsis, or requires hospitalization.
Key Management Principles
When to Continue Jardiance
Uncomplicated cystitis with mild-to-moderate symptoms: Continue Jardiance while treating the UTI with appropriate first-line antibiotics (nitrofurantoin, fosfomycin, or trimethoprim-sulfamethoxazole for 3-7 days) 1.
SGLT2 inhibitors like dapagliflozin (similar class to Jardiance) show only a slightly increased risk of UTI (4.3-5.7% vs 3.7% placebo), with most infections being mild-to-moderate and responding to standard antimicrobial treatment 2.
Research demonstrates that UTIs in SGLT2 inhibitor-treated patients are generally clinically manageable without medication discontinuation 2.
When to Hold Jardiance
Temporarily discontinue in these situations:
Complicated UTI with systemic symptoms (fever, flank pain, rigors, altered mental status) requiring hospitalization 1.
Signs of sepsis or septic shock where broad-spectrum IV antibiotics are needed 1.
Pyelonephritis (upper tract infection) requiring more intensive treatment 1.
Inability to maintain adequate oral intake due to infection severity, as SGLT2 inhibitors increase dehydration risk 2.
Duration of Hold (If Discontinued)
Resume Jardiance once the patient is afebrile for 48 hours, tolerating oral intake, and showing clinical improvement 1.
For uncomplicated UTI: If held, can typically resume after 3-5 days once symptoms resolve with antibiotic therapy 1, 3.
For complicated UTI: Hold until completion of 7-14 days of antibiotic therapy and confirmed clinical resolution 1, 4.
Important Clinical Caveats
Antibiotic Selection Matters
Use first-line agents (nitrofurantoin, fosfomycin, pivmecillinam) for uncomplicated cystitis, treating for 3-5 days 1, 3.
For complicated UTI requiring hospitalization, initiate broad-spectrum IV therapy (third-generation cephalosporin or aminoglycoside combination) 1, 5.
Obtain urine culture before starting antibiotics to guide therapy, especially in complicated cases 1.
Risk Stratification
Higher risk patients (diabetes, immunosuppression, anatomic abnormalities, recent instrumentation) may warrant holding Jardiance even for seemingly uncomplicated UTI 1, 6.
The glucosuria induced by SGLT2 inhibitors does not show a definitive dose-relationship with UTI incidence, and most infections remain manageable 2.
Discontinuation due to UTI is rare (0.3% in clinical trials) 2.
Monitoring During Treatment
Ensure adequate hydration throughout UTI treatment, as both infection and SGLT2 inhibitors can contribute to volume depletion 2.
If symptoms persist beyond 7 days despite antibiotics, repeat urine culture to guide further management 1.
For rapid recurrence (especially with same organism), consider holding Jardiance until urologic evaluation rules out anatomic abnormalities 1.