Jardiance (empagliflozin) causes side effects ranging from mild genital yeast infections to rare but serious complications like ketoacidosis. The most common issue, affecting up to 10% of women and 5% of men, is genital yeast infections caused by the drug’s core mechanism: flushing excess glucose out through your urine. Understanding which side effects are routine nuisances and which need urgent attention can help you use the medication safely.
How Jardiance Works (and Why It Causes Side Effects)
Your kidneys normally filter glucose from blood and then reabsorb nearly all of it back into circulation. A protein called SGLT2, located in the kidney’s filtration tubes, handles most of that reabsorption. Jardiance blocks SGLT2, which means more glucose stays in your urine instead of returning to your bloodstream. This lowers blood sugar effectively, but urine loaded with sugar creates a warm, glucose-rich environment that feeds yeast and bacteria. That single mechanism explains many of the drug’s most common side effects.
Genital Yeast Infections
Genital yeast infections are the most frequently reported side effect. In the large EMPA-REG OUTCOME trial, 10% of women and 5% of men taking Jardiance developed a genital yeast infection, compared to far fewer on placebo. A Canadian study of over 21,000 patients on SGLT2 inhibitors found similar numbers: 10.7% of women and 4.3% of men. These infections typically cause itching, irritation, and discharge, and they respond well to standard antifungal treatments. They’re more of an ongoing management issue than a dangerous complication, but recurrent infections can become frustrating.
Urinary Tract Infections
Many people assume that sugar in the urine would also increase urinary tract infections (UTIs). Clinical data, however, tells a more nuanced story. A large review published in the Journal of the American College of Cardiology found that SGLT2 inhibitors are associated with increased genital yeast infections but not a statistically significant increase in standard UTIs. That said, the FDA prescribing information does warn about serious urinary complications, including kidney infections (pyelonephritis) and bloodstream infections originating from the urinary tract (urosepsis), which have occurred in some patients. These severe cases are rare but have required hospitalization.
Dehydration and Low Blood Pressure
Because Jardiance pushes extra glucose and water out through urine, you may urinate more frequently, especially in the first weeks. This can lead to mild dehydration, dizziness, or lightheadedness when standing up. Older adults, people taking blood pressure medications, and those on diuretics face a higher theoretical risk. In practice, though, large clinical trials found that volume depletion and symptomatic low blood pressure occurred at comparable rates in patients taking Jardiance and those on placebo. Staying well hydrated is still a sensible precaution, particularly in hot weather or during illness.
Ketoacidosis With Normal Blood Sugar
The most dangerous side effect to watch for is a type of ketoacidosis that can strike even when blood sugar levels look relatively normal, sometimes below 250 mg/dL. This is called euglycemic ketoacidosis, and it’s deceptive because the blood sugar reading doesn’t raise the alarm the way it would in typical diabetic ketoacidosis. Your body shifts to burning fat for energy, producing acids called ketones that build up in the blood.
The risk is highest in people with type 1 diabetes (Jardiance is not approved for blood sugar control in type 1), but it has also been reported in people with type 2 diabetes. A history of pancreatitis or pancreatic surgery raises the risk further. Fatal cases have occurred.
Symptoms to know include nausea, vomiting, abdominal pain, unusual fatigue, and shortness of breath. Because blood sugar may not be dramatically elevated, these symptoms can be mistaken for a stomach bug or general illness. If you experience this combination, especially the shortness of breath alongside nausea, seek medical evaluation promptly. Situations that stress the body, like surgery, prolonged fasting, heavy alcohol use, or severe illness, can trigger it.
Fournier’s Gangrene
Fournier’s gangrene is a rare but life-threatening infection of the tissue around the genitals and the area between the genitals and rectum. It has been reported in patients taking SGLT2 inhibitors, including Jardiance. The FDA prescribing label specifically warns about this complication, noting that cases have required multiple surgeries and some have been fatal.
Early signs include tenderness, redness, or swelling in the genital or perineal area, along with fever above 100.4°F (38°C) or a general feeling of being unwell. The infection can worsen within hours, so any combination of these symptoms warrants immediate medical attention. If Fournier’s gangrene is suspected, the medication should be stopped.
Kidney Function Considerations
Jardiance depends on kidney function to work. The drug is not appropriate for people with severely reduced kidney filtration (an eGFR below 30) and is contraindicated entirely for those with end-stage kidney disease or on dialysis. It generally should not be started when eGFR is below 45 and should be discontinued if kidney function drops persistently below that threshold. Your prescriber will check kidney function before starting the medication and periodically afterward. A temporary, mild dip in kidney filtration can occur early in treatment and usually stabilizes.
Weight Loss and Other Beneficial Effects
Not all of Jardiance’s secondary effects are unwanted. Because the drug causes your body to excrete glucose (and the calories it contains) through urine, modest weight loss is common. In pooled clinical data from over 2,400 adults with type 2 diabetes, those taking Jardiance lost an average of about 4 pounds (1.9 kg) more than those on placebo over 24 weeks. A shorter 12-week study showed roughly 3.7 pounds (1.7 kg) of additional weight loss. The weight reduction tends to come partly from fat, including abdominal fat, and partly from fluid loss related to the drug’s mild diuretic effect. This isn’t dramatic weight loss, but many patients view it as a welcome bonus alongside better blood sugar control.
Common but Manageable Effects
Beyond the side effects above, people taking Jardiance frequently report increased urination (a direct consequence of flushing glucose), mild thirst, and occasional nausea. Joint pain has also been noted in some patients on SGLT2 inhibitors. These effects tend to be most noticeable in the first few weeks and often improve as your body adjusts. Keeping a water bottle handy and being prepared for more frequent bathroom trips, particularly early on, helps most people manage comfortably.