Jardiance (empagliflozin) belongs to the SGLT2 inhibitor class, a group of diabetes drugs that also protect the heart and kidneys in ways no one expected when they were first developed. More than 10 million prescriptions are filled annually in the U.S., and the medication’s benefits extend well beyond blood sugar control. But Jardiance side effects stem directly from how the drug works — by flushing glucose through your urine — and that mechanism creates a set of predictable risks that every patient should understand before starting treatment.
How Jardiance Works
Jardiance blocks the sodium-glucose co-transporter 2 (SGLT2) protein in the kidneys, which normally reabsorbs about 90% of the glucose filtered from your blood. By blocking SGLT2, Jardiance forces your body to excrete approximately 70 grams of glucose per day through urine. This lowers blood sugar, reduces caloric intake (contributing to modest weight loss), and promotes mild fluid loss that helps lower blood pressure.
The FDA has approved Jardiance for type 2 diabetes, heart failure (both with reduced and preserved ejection fraction), and reducing cardiovascular death risk in adults with type 2 diabetes and established cardiovascular disease. The landmark EMPA-REG OUTCOME trial, published in the New England Journal of Medicine, demonstrated a 38% reduction in cardiovascular death — a result that transformed how doctors think about diabetes treatment.
Common Jardiance Side Effects
The most frequently reported Jardiance side effects are directly tied to its glucose-flushing mechanism:
- Urinary tract infections (UTIs) — reported in approximately 7-9% of female patients and 3-4% of males; excess glucose in the urine creates a favorable environment for bacteria
- Genital yeast infections — affect roughly 4-6% of women and 1-3% of men; the sugar-rich urine promotes fungal growth
- Increased urination (polyuria) — occurs in about 3-4% of patients, particularly during the first weeks
- Thirst — reported by approximately 2-3% of users, linked to the mild diuretic effect
- Upper respiratory tract infections — noted in about 3% of patients
- Joint pain — reported in roughly 2% of users
Genital infections are the side effect unique to SGLT2 inhibitors. Both yeast infections (vulvovaginal candidiasis in women, balanitis in men) and bacterial infections of the genital area can occur. Good hygiene, staying well-hydrated, and promptly treating any infection reduces complications. Most infections respond to standard antifungal or antibiotic therapy.
Hypoglycemia — Less Than You’d Expect
When used alone, Jardiance carries a low risk of hypoglycemia because its mechanism is glucose-dependent — once blood sugar normalizes, less glucose is excreted. However, combining Jardiance with insulin or sulfonylureas (glipizide, glimepiride) significantly increases hypoglycemia risk. Your doctor may reduce the dose of these medications when adding Jardiance to your regimen.
Serious Side Effects of Jardiance
Diabetic Ketoacidosis (DKA)
Euglycemic DKA — ketoacidosis occurring at normal or near-normal blood sugar levels — is a rare but dangerous complication of SGLT2 inhibitors. The FDA issued a safety warning about this risk, which affects fewer than 0.1% of patients but can be life-threatening. Unlike typical DKA (which presents with very high blood sugar), euglycemic DKA can be missed because glucose readings appear acceptable.
Risk factors include surgery, prolonged fasting, severe illness, heavy alcohol use, and reduced insulin doses. Symptoms to watch for include nausea, vomiting, abdominal pain, fatigue, and difficulty breathing. If you’re scheduled for surgery, most guidelines recommend stopping Jardiance at least three days beforehand.
Fournier’s Gangrene (Necrotizing Fasciitis of the Perineum)
This rare but devastating infection of the genital and perineal area has been linked to SGLT2 inhibitors, prompting an FDA boxed warning. Cases are extremely rare — fewer than 100 were reported in the initial post-marketing period across all SGLT2 inhibitors — but the condition requires emergency surgical treatment. Warning signs include severe pain, tenderness, redness, or swelling in the genital or perineal area, along with fever.
Acute Kidney Injury
Although Jardiance is actually protective for kidneys in long-term use, acute kidney injury can occur, particularly in patients who become dehydrated. Older adults, patients taking diuretics or NSAIDs, and those with pre-existing kidney impairment are at highest risk. The Mayo Clinic recommends ensuring adequate fluid intake, especially during hot weather or illness.
Hypotension and Volume Depletion
Jardiance’s mild diuretic effect can cause low blood pressure, dizziness, and dehydration — particularly in patients already taking blood pressure medications like losartan or metoprolol, diuretics, or those with impaired fluid intake. Symptoms include lightheadedness upon standing, fatigue, and decreased urine output despite increased thirst.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience symptoms of DKA (persistent nausea, vomiting, abdominal pain, difficulty breathing), signs of Fournier’s gangrene (severe genital/perineal pain with fever), severe dehydration with confusion, or inability to keep fluids down.
Drug Interactions
Jardiance has relatively few drug-drug interactions compared to many diabetes medications, but several combinations require attention:
- Insulin and sulfonylureas — increased hypoglycemia risk; dose adjustments of these drugs are usually needed
- Diuretics — loop diuretics (furosemide) and thiazides can compound volume depletion and increase dehydration and kidney injury risk
- Lithium — the diuretic effect of Jardiance may affect lithium levels
- UGT inducers — rifampin may reduce Jardiance effectiveness, though this interaction is considered modest
- Positive urine glucose tests — Jardiance causes glucose in urine, which will produce false-positive results on urine glucose monitoring; use blood glucose testing instead
For comprehensive medication guidance, see our medical conditions guide. Patients taking Mounjaro or other GLP-1 medications alongside Jardiance should discuss the combined effects with their endocrinologist.
Long-Term Benefits That Balance the Risks
Context matters when evaluating Jardiance side effects. Multiple large-scale trials have demonstrated remarkable long-term benefits:
- 38% reduction in cardiovascular death in diabetic patients with established CVD (EMPA-REG OUTCOME)
- Hospitalization for heart failure reduced by approximately 35%
- Kidney disease progression slowed significantly, with studies showing reduced risk of dialysis or kidney transplant
- Modest weight loss of 2-4 kg sustained over time
- Blood pressure reduction of approximately 3-5 mmHg systolic
According to the Cleveland Clinic, these cardiovascular and renal benefits have made SGLT2 inhibitors recommended for nearly all type 2 diabetes patients with heart disease or chronic kidney disease, regardless of blood sugar levels.
When to Call Your Doctor
Reach out to your prescriber if you experience:
- Recurrent UTIs or genital infections
- Signs of dehydration — extreme thirst, very dry mouth, infrequent urination, dark urine
- Nausea, vomiting, or abdominal pain that doesn’t resolve
- Unexplained fatigue or difficulty breathing
- Pain, tenderness, or redness in the genital area
- Dizziness or lightheadedness when standing
- Decreased urine output despite drinking adequate fluids
Frequently Asked Questions
Does Jardiance cause weight loss?
Yes. Jardiance typically produces modest weight loss of about 4-6 pounds over the first six months, primarily from caloric loss through glucose excretion and mild fluid loss. While this isn’t as dramatic as GLP-1 medications, it’s a welcome benefit for many diabetic patients, particularly since many other diabetes drugs cause weight gain.
Can I take Jardiance if I have kidney disease?
Jardiance can be initiated in patients with an eGFR of 20 mL/min or higher for heart failure and CKD indications, though its glucose-lowering effect diminishes with lower kidney function. For the diabetes indication alone, it’s typically started when eGFR is above 30. Kidney function should be monitored before starting and periodically during treatment.
Should I stop Jardiance before surgery?
Most guidelines recommend stopping Jardiance at least three days before scheduled surgery to reduce the risk of euglycemic DKA. The stress of surgery, fasting, and anesthesia all increase DKA risk. Inform your surgical team that you take an SGLT2 inhibitor. Your endocrinologist can advise on glucose management during the perioperative period.
Does Jardiance interact with metformin?
Jardiance and metformin work through different mechanisms and are commonly prescribed together with no significant drug-drug interaction. In fact, the combination tablet Synjardy contains both empagliflozin and metformin. The combined regimen provides complementary blood sugar control and may offer additive cardiovascular benefits.
Bottom Line on Jardiance Side Effects
The most common Jardiance side effects — UTIs, genital infections, and increased urination — are direct consequences of the drug’s glucose-flushing mechanism and are usually manageable. Serious risks like DKA and Fournier’s gangrene are exceptionally rare but require awareness and prompt action. For the vast majority of patients, Jardiance’s proven heart and kidney protection far outweigh its side effect risks. Stay hydrated, maintain good hygiene, know the warning signs, and keep your follow-up appointments for lab monitoring.