Jardiance (empagliflozin) is FDA-approved and generally safe for most adults when used as directed. It has a well-established safety profile backed by large clinical trials, and it offers proven benefits beyond blood sugar control, including significant reductions in cardiovascular death and heart failure hospitalization. That said, it does carry specific risks that certain people need to watch for, and it’s not appropriate for everyone.
What Jardiance Is Approved For
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work by causing your kidneys to flush excess sugar out through urine. The FDA has approved it for four uses: improving blood sugar control in adults and children 10 and older with type 2 diabetes, reducing cardiovascular death in adults with type 2 diabetes and established heart disease, reducing cardiovascular death and hospitalization in adults with heart failure, and slowing kidney disease progression in adults with chronic kidney disease at risk of getting worse.
The cardiovascular benefits are substantial. In the major EMPA-REG OUTCOME trial, Jardiance reduced cardiovascular death by 38%, all-cause death by 32%, and hospitalization for heart failure by 35% compared to placebo in patients with type 2 diabetes and existing heart disease. These results are a big part of why many doctors now prescribe Jardiance not just for blood sugar but for heart and kidney protection.
Common Side Effects
The most frequent side effects involve infections, which makes sense given how the drug works. By pushing sugar into your urine, Jardiance creates an environment where yeast and bacteria can thrive more easily.
In pooled clinical trial data, genital yeast infections affected about 5 to 6% of women taking Jardiance, compared to 1.5% on placebo. For men, genital fungal infections occurred in about 1.6 to 3.1%, versus 0.4% on placebo. Urinary tract infections were reported in roughly 7.6 to 9.3% of patients on Jardiance, though the difference from placebo was small. These infections are typically mild and treatable, but they’re worth knowing about so you can catch them early.
You may also urinate more frequently, which is part of how the drug lowers blood sugar. Staying well hydrated helps with this.
Rare but Serious Risks
Jardiance carries warnings for a few uncommon but potentially dangerous conditions.
Ketoacidosis: This is a buildup of acid in the blood that normally occurs when blood sugar is very high, but with SGLT2 inhibitors, it can happen even when blood sugar levels look normal or only slightly elevated. That’s what makes it tricky to catch. Symptoms include nausea, vomiting, abdominal pain, difficulty breathing, unusual fatigue, and a sweet smell on the breath. The risk goes up during periods of prolonged fasting, illness, or after surgery. If you’re scheduled for a procedure, your prescriber will likely have you stop Jardiance temporarily.
Fournier’s gangrene: This is a rare, fast-moving infection of the skin around the genitals or perineum. It’s extremely uncommon but serious enough to require immediate medical attention. Warning signs include pain, redness, swelling, or tenderness in the genital area, especially with fever. These symptoms can worsen quickly.
Acute kidney injury: Post-marketing reports have documented cases of sudden kidney problems in some patients, occasionally requiring hospitalization. This risk is higher if you’re already dehydrated or taking other medications that affect kidney function.
Safety Concerns for Older Adults
People 75 and older face higher rates of certain side effects. Volume depletion, which can cause dizziness, lightheadedness, or fainting from low blood pressure, affected 4.4% of older adults on the higher dose of Jardiance compared to 2.1% on placebo. Urinary tract infections also climbed, hitting about 15% in older patients on Jardiance versus 10.5% on placebo.
These risks are manageable with proper monitoring, but they’re especially important if you’re already taking water pills (diuretics) or have reduced kidney function. Your prescriber should check your hydration status before starting Jardiance and monitor your blood pressure afterward.
Kidney Function and Monitoring
Your kidney function needs to be checked before starting Jardiance and periodically while you’re on it. The standard measure is eGFR, a blood test that estimates how well your kidneys filter waste. If your eGFR drops below 60, you’ll need more frequent monitoring. Jardiance should be stopped if your eGFR stays persistently below 45.
Beyond kidney labs, your prescriber will track your blood sugar and HbA1c levels to assess long-term control. One practical note: urine glucose tests won’t work while you’re on Jardiance because the drug deliberately pushes sugar into urine, so those results will always look abnormal regardless of your actual blood sugar level. Blood-based tests are the reliable option.
Interactions With Other Medications
Jardiance can amplify the blood-sugar-lowering effects of insulin and certain other diabetes drugs, raising the risk of hypoglycemia (blood sugar dropping too low). If you’re on insulin, your dose may need adjusting when you start Jardiance.
Taking Jardiance alongside diuretics increases the chance of dehydration and low blood pressure, since both medications promote fluid loss. This combination requires closer monitoring, particularly in hot weather or during illness when you’re already losing fluids.
Pregnancy and Breastfeeding
Jardiance is not recommended during the second and third trimesters of pregnancy. Animal studies showed adverse effects on fetal kidney development, and there isn’t enough human data to rule out risk. If you become pregnant while taking Jardiance, contact your prescriber promptly to discuss alternatives for blood sugar management.
Breastfeeding while on Jardiance is also not recommended. Because infant kidneys are still maturing during the first two years of life, exposure to the drug through breast milk could potentially interfere with kidney development.
Signs to Watch For
Most people tolerate Jardiance well, but knowing what to watch for makes it safer. Contact your healthcare provider if you notice symptoms of a urinary tract infection (burning with urination, cloudy urine, increased urgency) or a yeast infection (itching, discharge, redness in the genital area). These are common and treatable but shouldn’t be ignored.
Seek prompt attention for any signs of ketoacidosis: persistent nausea, vomiting, stomach pain, difficulty breathing, or unusual fatigue. The same goes for genital pain, redness, or swelling with fever, which could signal a more serious infection. Dizziness or lightheadedness when standing, especially early in treatment, may indicate dehydration. Increasing your fluid intake and rising slowly from sitting positions can help, but let your prescriber know if it persists.