Short answer: They can raise the risk a little, and every label warns about rare serious infections. In label trials, urinary tract infections ran 9.3% on Jardiance 10 mg against 7.6% on placebo, and 5.7% on Farxiga 5 mg against 3.7%. A review of 77 trials found no clear overall rise. The labels warn that urosepsis and kidney infections have occurred and needed hospital care.
SGLT2 inhibitors lower blood sugar by sending extra glucose out in the urine. Each label says this increases the risk of genitourinary infections, including urinary tract infections (UTIs) and genital yeast infections, in men and women (Jardiance and Farxiga section 5.3, Invokana and Steglatro 5.4). See SGLT2 inhibitor.
UTIs are among the most common side effects in the label highlights, those seen in 5% or more of people: Jardiance lists them with female genital yeast infections, Farxiga with genital yeast infections and colds, and Invokana with genital yeast infections and passing more urine.
| Medicine | Placebo | Lower dose | Higher dose |
|---|---|---|---|
| Jardiance (empagliflozin) | 7.6% | 9.3% (10 mg) | 7.6% (25 mg) |
| Farxiga (dapagliflozin) | 3.7% | 5.7% (5 mg) | 4.3% (10 mg) |
| Invokana (canagliflozin) | 3.8% | 5.9% (100 mg) | 4.4% (300 mg) |
| Steglatro (ertugliflozin), VERTIS CV | 10.2% | 12.2% (5 mg) | 12.0% (15 mg) |
The rise was not tied to dose: for Jardiance, Farxiga and Invokana, the lower dose had the higher rate. Jardiance reports UTIs were more common in women (16.6% placebo, 18.4% and 17.0% on Jardiance) than in men (3.2%, 3.6% and 4.1%), and that people with a history of chronic or repeated UTIs were more likely to get one. In VERTIS CV, serious UTIs were 0.8% on placebo, 0.9% on 5 mg and 0.4% on 15 mg.
A review of 77 randomized trials with 50,820 people (Liu 2017) found no significant difference in UTIs overall (risk ratio 1.05), while genital infections were more than three times as common (risk ratio 3.30).
Every label warns that serious genitourinary infections, including urosepsis (infection spreading to the blood) and pyelonephritis (kidney infection), have occurred in people taking SGLT2 inhibitors, and some needed hospital care. The labels tell clinicians to watch for signs and treat promptly. The same section covers Fournier's gangrene, a rare infection of the genital area, explained in genital yeast infections on SGLT2 medicines.
The Farxiga, Invokana and Steglatro Medication Guides list UTI signs to report: burning when urinating, needing to urinate often or right away, pain in the lower belly or pelvis, and blood in the urine, sometimes with fever, back pain, nausea or vomiting. Fever or back pain can point to a kidney infection.
Anyone with past repeat UTIs can mention it before starting, as the Medication Guides ask. Dose Track can log each dose with a note on symptoms and when an infection was treated, which helps the prescriber judge whether there is a pattern.
Read more on Dose Track: SGLT2 inhibitor · Jardiance side effects · Farxiga side effects · Jardiance vs Farxiga