Switching from Jardiance to Farxiga is NOT Recommended for Patients with Recurrent Yeast Infections
If a patient cannot tolerate even the lowest dose of Jardiance (empagliflozin) due to severe yeast infections, switching to Farxiga (dapagliflozin) is unlikely to be successful, as both SGLT2 inhibitors share the same mechanism-based risk of genital mycotic infections. 1
Why SGLT2 Inhibitors Cause Yeast Infections
- All SGLT2 inhibitors, including both empagliflozin and dapagliflozin, increase urinary glucose excretion, which creates a glucose-rich environment in the genitourinary tract that promotes fungal growth 1
- This is a class effect, not a drug-specific adverse reaction—meaning all SGLT2 inhibitors carry similar risks of genital mycotic infections 2
- The FDA drug label for dapagliflozin explicitly warns that "dapagliflozin increases the risk of genital mycotic infections" and that "patients with a history of genital mycotic infections were more likely to develop genital mycotic infections" 1
Evidence Against Switching Between SGLT2 Inhibitors
- In clinical trials, genital mycotic infections occurred in approximately 5-8% of patients on dapagliflozin compared to 1% on placebo 1, 3
- A large real-world audit of 1,049 patients on dapagliflozin found that prior history of genital fungal infection was the strongest predictor of recurrent infections (adjusted OR 2.41,95% CI 1.04-5.57, P=0.039) 4
- Female patients had a 4-fold higher risk of genital infections with dapagliflozin compared to males (13.2% vs 3.3%, adjusted OR 4.22, P<0.001) 4
Alternative Treatment Strategies
Instead of switching to another SGLT2 inhibitor, consider GLP-1 receptor agonists as the preferred alternative for cardiovascular and renal protection:
- GLP-1 receptor agonists (liraglutide, semaglutide) provide comparable cardiovascular benefits to SGLT2 inhibitors without the risk of genital infections 2
- The 2018 ACC Expert Consensus recommends that "GLP-1RAs with demonstrated CV benefit offer reductions in MACE but are associated with transient nausea and vomiting, especially when initiating therapy" rather than genital infections 2
- For patients with established cardiovascular disease or heart failure, GLP-1 receptor agonists remain a Class I recommendation alongside SGLT2 inhibitors 2
If SGLT2 inhibitor therapy is absolutely necessary for heart failure or renal protection:
- The ACC guidelines acknowledge that SGLT2 inhibitors "increase the risk of genital mycotic infections" and recommend that "patients should be informed about the higher risk of genital mycotic infections, and that this risk could be lowered with meticulous attention to personal hygiene" 2
- Topical antifungal agents can be used for initial treatment, with oral antifungals reserved for persistent cases 2
- However, if a patient cannot tolerate even the lowest dose of one SGLT2 inhibitor, attempting another is unlikely to succeed given the shared mechanism 1
Critical Clinical Caveat
The key issue is that if yeast infections were severe enough to prevent tolerating the lowest dose of empagliflozin (10 mg), the patient has demonstrated intolerance to the entire SGLT2 inhibitor class. 4 The real-world data shows that patients with prior genital infections have more than double the risk of recurrence with any SGLT2 inhibitor 4, making cross-class switching futile in this scenario.
Recommended Approach
- Discontinue SGLT2 inhibitor therapy entirely if genital infections prevent tolerating even the lowest dose 1
- Initiate a GLP-1 receptor agonist (liraglutide 1.8 mg daily or semaglutide 1-2 mg weekly) for cardiovascular risk reduction 2
- Consider DPP-4 inhibitors (sitagliptin) as add-on therapy if additional glycemic control is needed, as these have neutral cardiovascular effects and no genital infection risk 5
- Maintain metformin as the foundation of therapy unless contraindicated 2