Is Jardiance Safe to Take? Risks and Side Effects

Jardiance (empagliflozin) has a well-established safety record across multiple large clinical trials, and most people tolerate it without serious problems. The landmark EMPA-REG OUTCOME trial, which enrolled over 7,000 patients with type 2 diabetes and cardiovascular disease, found that rates of adverse events, serious adverse events, and events leading to discontinuation were similar between empagliflozin and placebo, with one clear exception: genital infections were more common in the empagliflozin group. That said, the drug does carry a handful of risks that range from mildly annoying to genuinely dangerous, and whether it is safe for you depends on your individual health picture.

How Jardiance Works and Why That Matters for Side Effects

Jardiance belongs to a class of drugs called SGLT2 inhibitors. It works in the kidneys by blocking a transporter that normally reabsorbs glucose back into the bloodstream. With that transporter inhibited, the kidney’s capacity to reclaim glucose drops substantially, and excess sugar spills into the urine instead.¹ This mechanism is the root cause of nearly every side effect associated with the drug. Sugar-laden urine creates a hospitable environment for yeast and bacteria. The extra glucose in the urine also pulls water with it, which is why dehydration and blood pressure drops are a concern. Understanding this one mechanism makes the rest of the side-effect profile intuitive.

The Most Common Side Effect: Genital Yeast Infections

If Jardiance has a signature nuisance, it is genital mycotic (yeast) infections. Sugar in the urine feeds Candida and related organisms, and the warm, moist genital area becomes an easy target. This was consistently the only adverse event that occurred more often in empagliflozin-treated patients than in placebo groups across the major cardiovascular outcome trial.² Women tend to be affected more than men, though men can develop balanitis (inflammation of the foreskin area). The infections are usually mild, treatable with over-the-counter antifungals, and for many people they occur once or twice after starting the medication and then stop recurring. Good hygiene, keeping the area dry, and promptly treating early symptoms all help. For some patients, though, recurrent infections are bothersome enough to warrant switching to a different drug class.³

Urinary Tract Infections Are Less of a Concern Than You Might Expect

Early on, there was worry that funneling extra sugar through the urinary tract would lead to more urinary tract infections. The data turned out to be more reassuring than expected. In the large EMPA-REG OUTCOME trial, the overall rate of UTIs was virtually identical: about 18% in both the empagliflozin and placebo groups. Complicated UTIs (serious infections like pyelonephritis or urosepsis) were also similar at roughly 1.7–1.8% in both groups.⁴ So while the drug does increase genital infections, it does not appear to meaningfully increase the risk of bladder or kidney infections for most people. If you are someone who already gets frequent UTIs, this is still worth discussing with your prescriber, but the blanket fear of UTIs with this medication class has softened considerably.

Dehydration and Low Blood Pressure

Because Jardiance causes you to urinate more (you’re literally flushing out glucose and the water that follows it), volume depletion is a real concern, particularly in certain groups. In EMPA-REG OUTCOME, events consistent with volume depletion occurred at similar low rates in both empagliflozin and placebo groups (about 5% each), and swelling was actually less common in the empagliflozin group than in the placebo group.⁵ For the average patient, this means Jardiance’s mild diuretic effect is manageable and may even help with fluid retention.

The risk goes up, however, in older adults, people already taking diuretics (“water pills”), and anyone with limited fluid intake. A published case report described an elderly patient who developed severe dehydration and cardiac arrest after starting empagliflozin, compounded by the patient’s other medical conditions.⁶ That is an extreme outcome, but it underscores why staying well-hydrated matters on this drug. If you feel lightheaded when standing up, notice a sudden drop in urine output, or are going through a period of illness with vomiting or diarrhea, those are signals to contact your doctor rather than push through.

The Overlap with Diuretics and Fall Risk

Many people prescribed Jardiance for heart failure or diabetes are already taking a loop or thiazide diuretic. Both drug classes push fluid out of the body, so combining them can amplify the risk of low blood pressure, dizziness, and falls. A clinical review examining this exact overlap in older heart failure patients noted that the fall-related side-effect profiles of diuretics and SGLT2 inhibitors partly overlap, particularly the tendency to cause hypotension, but also have important differences.⁷ In practice, many prescribers will reduce the diuretic dose when adding Jardiance, especially in older patients. If you are on both, pay attention to symptoms like dizziness when standing or unusual fatigue.

Interestingly, a large European pharmacovigilance analysis found that SGLT2 inhibitors were actually associated with a lower probability of reported falls compared to another class of diabetes drugs (DPP4 inhibitors). For empagliflozin specifically, this lower probability held for adults under 65 but became less clear in those 65 and older.⁸ So the fear that Jardiance is a major fall hazard on its own doesn’t hold up broadly, but the combination with other blood-pressure-lowering drugs deserves caution in older adults.

Euglycemic Diabetic Ketoacidosis: Rare but Dangerous

The most dangerous side effect to know about is euglycemic diabetic ketoacidosis (euDKA). Normal DKA is a medical emergency in which the body, starved of usable glucose, breaks down fat so aggressively that toxic acid byproducts (ketones) build up in the blood. Jardiance can trigger this same process while blood sugar stays deceptively normal or only slightly elevated. That is what makes it treacherous: the usual red flag for DKA, a sky-high glucose reading, may be absent.⁹

Euglycemic DKA on Jardiance tends to happen under specific circumstances: acute illness (surgery, infection, injury), significant decreases in carbohydrate intake (including fasting or very low-carb diets), or changes to insulin dosing.¹⁰ Symptoms include nausea, vomiting, abdominal pain, fatigue, and difficulty breathing. If you are on Jardiance and feel these symptoms, especially during illness or after skipping meals, do not wait to see if it passes. Emergency departments are increasingly aware of this complication, but the normal-looking blood sugar can still cause delays in diagnosis. Many prescribers recommend temporarily stopping Jardiance before planned surgery or during any illness that limits eating or drinking.

Fournier Gangrene: Extremely Rare but Worth Mentioning

Fournier gangrene is a severe, rapidly progressing infection of the genital and perineal area. It is exceptionally rare in the general population, and it remains rare even among SGLT2 inhibitor users, but the FDA flagged a signal. Between 2013 and early 2019, the agency identified 55 cases of Fournier gangrene across all SGLT2 inhibitors combined (not just Jardiance). Patients ranged in age from 33 to 87, and all required surgical intervention.¹¹ Given the millions of prescriptions written over that period, the absolute risk is vanishingly small. Still, any unusual pain, tenderness, redness, or swelling in the genital or perineal area should be evaluated promptly.

What Jardiance Does to Your Kidneys

Kidney effects are one of the most commonly misunderstood aspects of Jardiance. When you first start the drug, your kidney filtration rate (a measure called eGFR) typically dips. In the EMPA-KIDNEY trial, this initial drop was about 2 mL/min per 1.73 m² in the first two months, a roughly 6% decline.¹² That sounds alarming, but it is actually a sign the drug is doing what it is supposed to do: reducing pressure inside the glomeruli (the kidney’s tiny filtering units) by constricting the blood vessel that feeds them. Less pressure means less damage over time.¹³

After the initial dip, the long-term trajectory reverses. In the EMPA-KIDNEY analysis, empagliflozin halved the chronic annual rate of kidney function decline compared to placebo.¹² A large individual-participant meta-analysis confirmed that empagliflozin reduced the risk of kidney failure by about a third, reduced acute kidney injury events by roughly a quarter, and slowed chronic eGFR decline by about two-thirds. These benefits held regardless of whether the patient had diabetes or heart failure.¹⁴ For people with chronic kidney disease, this transforms Jardiance from a diabetes drug that happens to affect the kidneys into a kidney-protective drug in its own right. The EMPA-KIDNEY trial showed a 28% reduction in the combined risk of kidney disease progression or cardiovascular death.¹⁵

One important caveat: starting SGLT2 inhibitors when kidney function is already very low is generally not encouraged, because the initial eGFR dip may be poorly tolerated. And if you experience acute dehydration, very low blood pressure, or an acute kidney event, the drug should typically be paused until things stabilize.¹³

Cholesterol Changes

One side effect that gets less attention is a modest rise in LDL cholesterol. In a randomized, placebo-controlled study, empagliflozin increased LDL-C from a baseline average of about 103 mg/dL to 112 mg/dL after three months of treatment. Total cholesterol rose as well. LDL particle size did not change, meaning the particles got more numerous but not necessarily more dangerous in character.¹⁶ For someone whose LDL is already well-controlled with a statin, a bump of about 9 mg/dL is unlikely to change their risk profile. But if your cholesterol is borderline and you’re not on a statin, this is worth monitoring. Your doctor may want to check lipid panels a few months after starting Jardiance.

A Surprise Benefit for Gout and Uric Acid

Not everything on the metabolic side is a downside. Jardiance consistently lowers uric acid levels in the blood. In a post hoc analysis of EMPA-REG OUTCOME, empagliflozin reduced serum uric acid versus placebo, and the drop was more pronounced in patients who started with higher levels. Among patients not already on gout medication, those taking empagliflozin were about a third less likely to have a gout episode or start antigout therapy.¹⁷ A separate trial in heart failure patients with preserved ejection fraction showed empagliflozin lowered uric acid quickly (within four weeks) and reduced clinical events related to high uric acid by about 38%.¹⁸ A systematic review pooling 12 studies confirmed empagliflozin was more effective at lowering uric acid than placebo.¹⁹ If you have diabetes and also struggle with gout, this is a genuine two-for-one.

Safety in Older Adults

Age is one of the biggest practical concerns people have. An analysis of the EMPA-REG OUTCOME trial specifically looking at older patients found that empagliflozin’s side-effect profile was consistent across age groups. Rates of bone fractures, kidney-related adverse events, and diabetic ketoacidosis were similar between empagliflozin and placebo regardless of age.²⁰ That is reassuring, but clinical trials tend to enroll healthier patients than the average person walking into a clinic. Older adults who are frail, eating poorly, or taking multiple blood-pressure-lowering medications face a higher practical risk of dehydration and falls, even if the controlled-trial data look clean.

Bone Health

Within the SGLT2 inhibitor class, bone safety has been a point of divergence. Canagliflozin (Invokana) was associated with increased fracture risk in two large trials, prompting an FDA warning. Empagliflozin and dapagliflozin, by contrast, have not shown an overall increase in fracture risk in their major clinical trials, though subgroup analyses have suggested potential risks in specific populations. Empagliflozin does appear to increase urinary phosphate excretion and alter levels of hormones involved in bone and mineral metabolism, including parathyroid hormone and FGF23. Whether those shifts translate into meaningful bone loss over many years of use is still being studied. For now, routine bone-density monitoring is not recommended solely because of Jardiance use, but if you already have osteoporosis or are at high fracture risk, it is worth flagging with your doctor.

Type 1 Diabetes and Off-Label Use

Jardiance is not approved for type 1 diabetes, and using it in this population carries a substantially higher risk of diabetic ketoacidosis. A review of the evidence on SGLT2 inhibitors in type 1 diabetes acknowledged benefits in blood sugar control and cardiovascular risk factors but documented an important increase in DKA risk.²¹ Some clinics have experimented with strict off-label protocols that include patient education, ketone monitoring, and conservative dosing, and one such program reported only one mild DKA event.²² But without that kind of structured supervision, the risk is high enough that most guidelines advise against it. If you have type 1 diabetes and are curious about Jardiance, this is a conversation for an endocrinologist who understands the safeguards needed, not something to try based on a friend’s experience with type 2 diabetes.

Real-World Discontinuation Rates

Clinical trial data tell you what happens under ideal conditions. In the real world, where patients are sicker and follow-up is less structured, more people stop taking the drug. A real-world study examining SGLT2 inhibitor discontinuation found higher rates than in the landmark DAPA-HF trial, where only about 4.7% discontinued due to adverse events over 18 months. The researchers attributed the gap to the fact that real-world patients tend to be less healthy than those enrolled in randomized trials.²³ The most common reasons people stop in practice are the genital infections, urinary symptoms, and gastrointestinal issues. Many of these are manageable with dose adjustments or supportive measures, which means some people discontinue prematurely because they were not counseled on what to expect. If you are starting Jardiance, knowing that mild genital symptoms in the first few weeks are common and usually temporary can make the difference between sticking with a beneficial drug and abandoning it.

When to Pause or Stop Jardiance

There are specific situations where temporarily stopping Jardiance is the safest move, even if it is otherwise going well for you. These include:

Before surgery: Fasting combined with the metabolic stress of surgery raises DKA risk. Many surgical guidelines recommend stopping SGLT2 inhibitors at least three days before a planned procedure.
During acute illness: If you have a fever, are vomiting, or cannot keep food and fluids down, the combination of dehydration and reduced carbohydrate intake creates the conditions for euglycemic DKA. Pausing the drug and contacting your doctor is the standard advice.
Acute kidney events: If you experience sudden drops in kidney function, low blood pressure, or significant dehydration, it is prudent to hold the drug until things stabilize.
Very low-carb diets or prolonged fasting: Drastically cutting carbohydrates while on Jardiance can tip the body toward ketone overproduction. If you are considering a ketogenic diet or extended fast, talk to your prescriber first.

These are temporary pauses, not permanent stops. Once the acute situation resolves, most people restart without issues. The key is awareness: know the warning signs of DKA (nausea, vomiting, abdominal pain, unusual fatigue, fruity-smelling breath) and have a low threshold for seeking medical attention during any period of illness.