Jardiance (empagliflozin) most commonly causes genital yeast infections and urinary tract infections, with more serious but rare risks including a type of diabetic ketoacidosis that can occur even when blood sugar appears normal. The drug works by blocking glucose reabsorption in the kidneys, forcing excess sugar out through urine. That extra sugar in the urinary tract creates a favorable environment for infections and also pulls additional water from the body, which drives many of the side effects people experience.
How Jardiance Creates Side Effects
Your kidneys normally filter glucose out of the blood and then reabsorb almost all of it back into circulation. Jardiance blocks the protein responsible for most of that reabsorption, so a significant amount of glucose passes into your urine instead. This is how the drug lowers blood sugar, but it also means your urine consistently contains more sugar than usual, and your body loses more fluid in the process.
That sugar-rich urine is essentially a feeding ground for yeast and bacteria, which explains the increased infection rates. The extra fluid loss acts like a mild diuretic, lowering blood pressure modestly but also raising the risk of dehydration, especially in older adults or people already taking blood pressure medications.
Genital Yeast Infections
Genital yeast infections are the most distinctive side effect of Jardiance. In clinical trials, about 5.4% to 6.4% of women taking Jardiance developed vaginal yeast infections, compared to just 1.5% on placebo. For men, genital fungal infections occurred in 1.6% to 3.1% on Jardiance versus 0.4% on placebo. That means the drug roughly triples to quadruples the baseline risk for both sexes.
These infections are typically mild and treatable with standard antifungal medications. They’re more likely in the first few months of treatment and in people who have had yeast infections before. Keeping the genital area clean and dry can help reduce the risk, though it won’t eliminate it entirely.
Urinary Tract Infections
Urinary tract infections showed a more modest increase in trials. Overall, about 9.3% of patients on the 10 mg dose reported UTIs, compared to 7.6% on placebo. When broken down by sex, the difference was more visible in women: 18.4% on Jardiance 10 mg versus 16.6% on placebo. Men had lower rates across the board (3.6% versus 3.2%).
The increase is relatively small, but if you’re already prone to UTIs, it’s worth knowing that Jardiance can tip the balance. Symptoms to watch for include burning during urination, frequent urges to urinate, cloudy or strong-smelling urine, and pelvic discomfort.
Dehydration and Low Blood Pressure
Because Jardiance increases the volume of urine your body produces, it can lead to dehydration. Symptoms include dizziness when standing up quickly, lightheadedness, feeling unusually thirsty, and fatigue. This is particularly concerning for older adults, whose bodies already hold less water and whose reflexes for maintaining blood pressure when standing may be slower.
In one reported case, an elderly patient experienced repeated dizziness upon standing, a classic sign of orthostatic hypotension, which is a sudden drop in blood pressure triggered by position changes. For people over 65, or those already taking diuretics or blood pressure medications, this fluid loss can compound and increase the risk of falls. Staying well hydrated and standing up slowly can help, but persistent dizziness is worth reporting to your prescriber.
Low Blood Sugar With Certain Drug Combinations
Jardiance on its own rarely causes low blood sugar. In monotherapy trials, hypoglycemia occurred in just 0.4% of patients, identical to the placebo rate. The picture changes dramatically when Jardiance is combined with other diabetes medications that actively push blood sugar down.
When taken alongside metformin and a sulfonylurea, hypoglycemia rates jumped to 16.1% on Jardiance 10 mg, compared to 8.4% on placebo. With basal insulin, rates reached 19.5% to 28.4%. And for patients on multiple daily insulin injections, hypoglycemia affected roughly 40% of people regardless of whether they took Jardiance or placebo, though the Jardiance group trended slightly higher.
If you take insulin or a sulfonylurea alongside Jardiance, your prescriber may need to lower those doses. Recognizing hypoglycemia symptoms (shakiness, sweating, confusion, rapid heartbeat) matters more in these combinations.
Ketoacidosis With Normal Blood Sugar
The most serious rare side effect is a condition called euglycemic diabetic ketoacidosis. Normally, ketoacidosis happens when blood sugar is very high, making it easier to recognize. Jardiance can trigger a version where the blood becomes dangerously acidic even though blood sugar stays below 200 mg/dL. This makes it easy to miss.
The mechanism involves several overlapping changes. Jardiance appears to raise glucagon levels, a hormone that promotes fat breakdown and the production of acidic compounds called ketones. The drug also causes fluid and sodium loss, which triggers stress hormones that further accelerate ketone production. The result is a buildup of acid in the blood that can become life-threatening if not treated.
Certain situations raise the risk considerably: surgery, prolonged fasting, significant dehydration, heavy alcohol use, very low-carb or ketogenic diets, serious infections, and reducing or missing insulin doses. Symptoms include nausea, vomiting, abdominal pain, unusual fatigue, and difficulty breathing. Because blood sugar may look normal on a standard glucose check, this condition requires a blood test that measures ketone levels and blood acidity to diagnose. If you experience these symptoms, especially during illness or after surgery, seek medical attention promptly even if your blood sugar reading looks fine.
Fournier’s Gangrene
The FDA has issued a warning about Fournier’s gangrene, a rare but severe infection of the tissue around the genitals and perineum, in patients taking SGLT2 inhibitors like Jardiance. Real-world data found the incidence was approximately 3.8 cases per 100,000 person-years in SGLT2 inhibitor users, which is extremely low in absolute terms. For context, the rate in patients taking a different class of diabetes medication was nearly the same at 3.2 per 100,000 person-years.
Despite its rarity, Fournier’s gangrene is a surgical emergency. Any rapidly spreading redness, swelling, or tenderness in the genital or perineal area, especially with fever, should be evaluated immediately.
Initial Changes in Kidney Function
When you first start Jardiance, kidney function tests may show a small, expected dip. This happens because the drug changes how your kidneys handle fluid and sodium, temporarily reducing the filtration rate. This initial decline typically stabilizes and, in many cases, kidney function improves over the long term. Your prescriber will likely check kidney labs before starting Jardiance and periodically afterward to make sure the numbers stay in an acceptable range.
Less Common Side Effects
Beyond the headline effects, some people notice increased urination, which is a direct consequence of the drug’s mechanism. This is most noticeable in the first few weeks and often becomes less bothersome over time. Mild weight loss is also common, usually a few pounds, driven by the calorie loss from excreting glucose and the mild fluid reduction. Most people view this as a benefit rather than a side effect, but rapid or excessive weight loss can signal dehydration or inadequate calorie intake.
Modest blood pressure reduction is another expected effect. For many patients with type 2 diabetes who also have high blood pressure, this is actually helpful. But if your blood pressure is already well controlled or on the low side, the additional drop can cause symptoms of dizziness or fatigue, particularly in combination with other blood pressure medications.