Does Jardiance Increase Risk for UTI?
Yes, Jardiance (empagliflozin) does increase the risk of urinary tract infections, but the increase is modest and should not prevent its use given the substantial cardiovascular and renal protective benefits that far outweigh this risk. 1, 2
Mechanism of Increased UTI Risk
The persistent glucosuria created by empagliflozin's mechanism of action produces a glucose-rich environment in the genitourinary tract that promotes bacterial growth, directly increasing UTI risk. 1 This occurs because SGLT2 inhibitors work by blocking glucose reabsorption in the renal proximal tubules, leading to continuous urinary glucose excretion. 3
Quantified Risk from FDA Data
According to the FDA label, in pooled placebo-controlled clinical trials: 2
- Female patients: UTI incidence was 16.6% (placebo), 18.4% (Jardiance 10 mg), and 17.0% (Jardiance 25 mg) 2
- Male patients: UTI incidence was 3.2% (placebo), 3.6% (Jardiance 10 mg), and 4.1% (Jardiance 25 mg) 2
- Discontinuation rate: Only 0.1-0.2% of patients discontinued due to UTI 2
The absolute increase in UTI risk is approximately 1-2% compared to placebo, with women being significantly more affected than men. 2
Clinical Management Algorithm
Do not withhold empagliflozin solely due to UTI concerns in most patients, as the cardiovascular and renal protective benefits substantially outweigh the modest UTI risk. 1 Specifically, empagliflozin reduces: 1
- Incident or worsening nephropathy by 39%
- Doubling of serum creatinine with eGFR ≤45 mL/min/1.73 m² by 44%
- Cardiovascular death by 38%
- Heart failure hospitalization by 35%
High-Risk Populations Requiring Caution
Exercise particular caution in patients with: 4
- Bladder outlet obstruction or incomplete bladder emptying: Urinary stasis combined with glucosuria creates an especially high-risk environment for recurrent UTIs and potential urosepsis 4
- History of chronic or recurrent UTIs: These patients are more likely to experience UTIs on empagliflozin 2
- Female gender and age >50 years: Both are independent risk factors for UTI on SGLT2 inhibitors 5
When UTI Occurs
- Most UTIs are mild to moderate and respond to standard antimicrobial treatment 2, 6
- Continue empagliflozin during and after UTI treatment in most cases 1
- Consider discontinuation only if recurrent complicated UTIs develop, particularly in patients with bladder outlet obstruction 4
Important Distinction: Genital Mycotic Infections Are More Common
Genital mycotic infections (vaginal candidiasis, balanitis) are actually more common than UTIs with empagliflozin, occurring in approximately 6% of SGLT2 inhibitor users versus 1% on placebo. 3, 1 These require different management than UTIs and should not be confused with urinary tract infections. 1
Common Pitfall to Avoid
Do not discontinue empagliflozin when eGFR falls below 45 mL/min/1.73 m² due to concerns about UTI risk—the cardiovascular and renal benefits persist and are independent of glucose-lowering effects at lower eGFR levels. 3, 1 Continue until dialysis or transplantation. 3