Do GLP-1 Receptor Agonists Increase the Risk of Urinary Tract Infections?
No, GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide, tirzepatide) do not increase the risk of urinary tract infections. In fact, they appear to carry a lower risk of non-candida UTIs compared to other diabetes medications.
Direct Evidence on UTI Risk
The most definitive evidence comes from a large US nationwide insurance claims study that directly compared GLP-1 receptor agonists to SGLT2 inhibitors 1. GLP-1 receptor agonists were associated with a lower risk of non-candida UTIs compared to SGLT2 inhibitors (hazard ratios ≤0.91, P<0.001) 1. This protective effect remained consistent even in high-risk patients with prior UTIs, genitourinary malignancies, indwelling catheters, or other genitourinary abnormalities 1.
Tirzepatide specifically does not increase UTI risk. A systematic review and meta-analysis of 15 randomized controlled trials involving 14,471 patients found that tirzepatide at all doses (5 mg, 10 mg, 15 mg) did not increase the risk of urinary tract infections compared to placebo, insulin, or other GLP-1 receptor agonists 2.
Why the Confusion Exists
The confusion likely stems from SGLT2 inhibitors, which do increase genitourinary infection risk 3. SGLT2 inhibitors cause glucose to spill into the urine, creating a favorable environment for bacterial and fungal growth 3. This mechanism does not apply to GLP-1 receptor agonists, which work through completely different pathways—enhancing insulin secretion, suppressing glucagon, and delaying gastric emptying 3.
Clinical Context: Common Side Effects of GLP-1 Receptor Agonists
The most common side effects of GLP-1 receptor agonists are gastrointestinal symptoms—nausea, vomiting, and diarrhea—which occur mainly during initial treatment and gradually diminish over time 3. These medications do not cause the genitourinary tract infections seen with SGLT2 inhibitors 3.
Practical Implications
- You can reassure patients that GLP-1 receptor agonists will not increase their UTI risk 1, 2
- If a patient discontinued SGLT2 inhibitors due to recurrent UTIs, switching to a GLP-1 receptor agonist is an excellent alternative that maintains glycemic control and renal protection without the UTI risk 4
- Even in patients with genitourinary abnormalities (prior UTIs, indwelling catheters, GU malignancies), GLP-1 receptor agonists do not carry additional UTI risk 1
Important Caveat: Candida Infections
While GLP-1 receptor agonists do not increase UTI risk, SGLT2 inhibitors do increase the risk of candida (yeast) infections in the urinary and genital tracts 1. This distinction is important: bacterial UTIs are not increased by either drug class when GLP-1 RAs are used alone, but fungal infections are specifically associated with SGLT2 inhibitors, not GLP-1 receptor agonists 1.