Jardiance side effects and how to avoid them

Jardiance side effects | Weight loss | Anxiety | Gangrene | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Jardiance (active ingredient: empagliflozin) is a brand-name prescription drug that, along with diet and exercise, helps lower blood sugar in patients with Type 2 diabetes and reduce the risk of cardiovascular death in patients with both Type 2 diabetes and cardiovascular disease. Empagliflozin works by increasing the kidneys’ removal of glucose from the blood into the urine. Jardiance has several effects on the body and may not be right for everyone. Understanding the side effects, warnings, and drug interactions will help patients balance the pros and cons of taking Jardiance. 

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Common side effects of Jardiance

As with all prescription medications, Jardiance produces several possible side effects. Jardiance, however, will often be prescribed as a secondary treatment in combination with other diabetes medications such as metformin. Side effects, then, may vary between patients. The most common side effects, experienced by more than 5% of patients, are urinary tract infections and fungal infections of the vagina or penis.

Common side effects of Jardiance include:

• Urinary tract infections
• Genital mold or yeast infections
• Upper respiratory infections
• Increased urination
• Elevated levels of fats or cholesterol in the blood
• Joint pain
• Nausea and
• Kidney problems

Less commonly, Jardiance can lower blood volume and cause dehydration and low blood pressure.

Serious side effects of Jardiance

The most serious side effects of Jardiance include:

• Low blood pressure
• Low blood sugar
• Ketoacidosis
• Acute kidney impairment or injury
• Severe urinary tract infection (urosepsis)
• Kidney infection (pyelonephritis)
• Gangrene (necrotizing fasciitis of the perineum)
• Severe and potentially fatal allergic reactions such as angioedema or severe skin reactions

Ketoacidosis, a severe side effect of diabetes medications, occurs when ketones build up in the bloodstream as a result of the body using fats for fuel. Ketoacidosis is a potentially life-threatening medical emergency and is marked by symptoms such as intense thirst, frequent urination, nausea, abdominal pain, weakness, fatigue, and shortness of breath. Because of the increased risk for ketoacidosis or low blood sugar, both ketone and glucose levels should be checked regularly when Jardiance is being taken.

Jardiance weight loss

In addition to controlling blood sugar levels, Jardiance has been shown to reduce both weight and the distribution of body fat. In particular, Jardiance significantly reduces abdominal fat (visceral adiposity tissue or VAT). Abdominal body fat raises the risk of heart attack, stroke, and other cardiovascular events. Any reduction in belly fat helps reduce the risk of dying from heart disease or other cardiovascular conditions. 

Jardiance anxiety

Jardiance does not affect the nervous system. However, when taken with other diabetes medications, Jardiance can cause blood sugar to fall to dangerously low levels. Called hypoglycemia, low blood sugar causes the body to release epinephrine, better known as adrenaline. Many of the symptoms of low blood sugar are caused by this “adrenaline rush”: anxiety, fast heartbeat, palpitations, jitteriness, sweating, tremors, and nervousness. If taking Jardiance causes anxiety or any other symptoms of low blood sugar, take a fast-acting source of sugar such as fruit juice and seek immediate medical attention. Your healthcare provider may prescribe an emergency glucagon emergency kit if low blood sugar is a common occurrence.

Jardiance gangrene

In general, patients with diabetes are more vulnerable to bacterial and fungal infections. This is because bacteria and fungus consume glucose for energy. High blood glucose increases their food supply. High blood sugar also decreases the ability of the immune system to fight off infections. 

Jardiance decreases blood glucose levels by filtering glucose out of the bloodstream into the urine. This lowers blood sugar—which is a good thing—but makes urine sugary. Bacteria, yeast, and mold in the urinary tract and genitals thrive in this sugary environment. As a consequence, kidney, urinary tract, and genital infections are a common side effect of Jardiance.  

In rare cases, bacterial infections caused by Jardiance can run out of control and cause serious illnesses such as:

• Urosepsis (a bacterial overload in the urinary tract)
• Pyelonephritis (severe kidney infection)
• Fournier’s gangrene

Fournier’s gangrene results when a bacterial infection explodes out of control and starts attacking and killing tissues in the skin around the genitals and anus. Because it is a potentially life-threatening condition if left untreated, you should seek immediate medical attention if you’re taking Jardiance and notice symptoms of Fournier’s gangrene such as:

• Fever
• Feeling sick
• Moderate to severe swelling and pain in the genitals or around the anus
• Foul smell in the affected area
• Crackling, crunching, or popping sounds when you rub the area

Symptoms of Fournier’s gangrene can begin within the first week of taking Jardiance.

How long do Jardiance side effects last?

Common side effects of Jardiance may resolve the longer the medicine is taken. Jardiance typically clears from the body within a few days (half life is 12 hrs, so most of the drug is cleared within 24 hours, but takes several days for it to fully clear the body), so any minor side effects such as increased urination should fade within a day or two after the drug is discontinued. However, infections, liver abnormalities, and kidney injury may take days or weeks to resolve.

Jardiance contraindications & warnings

Jardiance is not the right medication for everyone. Because it works by increasing the kidney’s filtration of blood sugar, it is not appropriate for patients with severe or end-stage kidney disease or who are on dialysis. It should also not be given to anyone with a known hypersensitivity to empagliflozin, the active ingredient in Jardiance. In addition, people with diabetic ketoacidosis are not good candidates for Jardiance therapy. Jardiance is not for use in patients with Type 1 diabetes.

Jardiance comes with several warnings, including:

• The potential to cause low blood pressure in the elderly and in patients with renal impairment, low blood pressure, or who are taking diuretics (water pills)
• The need to monitor patients for signs of
  • Ketoacidosis
  • Kidney impairment or injury
  • Severe urinary infections
  • Fournier’s gangrene 
  • Fungal infections of the genitals
  • Low blood sugar and
  • Increase in “bad” cholesterol (LDL) levels

Older patients

Patients older than 65 are more likely to experience side effects such as low blood pressure, dehydration, or kidney problems.

Children

The FDA has not approved Jardiance for use in children younger than 18.

Renal impairment

Patients with decreased kidney function are at an increased risk for kidney impairment or kidney injury.

Pregnancy and breastfeeding

In general, Jardiance is discouraged for use by pregnant women in any trimester but is contraindicated in their second and third trimesters. However, there is little research linking Jardiance use during pregnancy to birth defects or miscarriage. 

While there are no studies showing how much Jardiance is present in breast milk, Jardiance should not be taken by nursing mothers. There is a possibility that even small amounts may impair the development of the nursing infant’s kidneys. 

Jardiance interactions

Jardiance has clinically significant interactions with several drugs. Many impair the ability of the body to eliminate Jardiance. These drugs increase the therapeutic benefit of Jardiance but also increase the risk and severity of side effects. Some drugs, such as diuretics, insulin, and drugs similar to Jardiance should be avoided when taking Jardiance.

SGLT2 inhibitors

Jardiance belongs to a family of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. These drugs work by shutting down a mechanism in the kidneys that returns glucose from the urine back into the bloodstream. As a result, patients on Jardiance excrete anywhere from 64 to 78 grams more of glucose a day depending on the dose prescribed. To avoid a hazardous drop in blood sugar, Jardiance should never be taken with other SGLT2 inhibitors: 

• Farxiga (dapagliflozin)
• Invokana (canagliflozin)
• Steglatro (ertugliflozin)

Diuretics

Diuretics (water pills) increase the amount of water and electrolytes excreted in the urine. They are commonly prescribed for a variety of medical conditions, most commonly high blood pressure and swelling due to water retention. Jardiance can interact with diuretics and cause higher-than-normal urination, resulting in dehydration and low blood volume, which can lead to low blood pressure. A healthcare provider might have to choose alternative therapies, reduce the diuretic dose, or monitor the patient closely.

Insulin and insulin stimulating medications

Insulin and drugs that increase the body’s production of insulin (insulin secretagogues) increase the risk of low blood sugar when they’re taken with Jardiance. Therapy will require regular blood sugar testing, and insulin doses may need to come down.

Some insulin secretagogues are commonly prescribed as a primary therapy along with Jardiance. These include glipizide, glyburide, and glimepiride. Other medications such as nateglinide and repaglinide also cause the body to secrete more insulin. Blood sugar will need to be regularly checked when combining Jardiance with any of these medications.

Other drugs

Finally, some drugs either increase or decrease the effects of Jardiance on blood sugar. Drugs that increase or complement Jardiance’s therapeutic effects also put people at risk for low blood sugar. These include:

• Diabetes medications such as metformin, pioglitazone, and acarbose
• Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Paxil (paroxetine)
• Monoamine oxidase inhibitors (MAOIs) such as Marplan (isocarboxazid), Nardil (phenelzine), or linezolid
• Quinolone antibiotics such as ciprofloxacin or levofloxacin
• Salicylates such as aspirin, ibuprofen, or diclofenac
• Barbiturates such as butalbital or barbital
• Bronchodilators such as doxofylline

On the other hand, corticosteroids such as dexamethasone, budesonide, and hydrocortisone increase the risk of high blood sugar when taken with Jardiance. 

Combining Jardiance with any of these drugs is safe as long as blood sugar is regularly monitored.

Finally, Jardiance also lowers blood pressure. In addition to removing glucose through the urine, Jardiance and similar drugs also filter out sodium, reducing the body’s total sodium content. For this reason, Jardiance should be taken cautiously in combination with blood pressure medications. Not only does the combination increase the risk of low blood pressure, but some blood pressure medications also raise the risk of low blood sugar or other side effects.

How to avoid Jardiance side effects

All medications have side effects. While side effects can’t be completely prevented, a few tips can help manage or minimize Jardiance side effects:

1.  Take Jardiance as directed

Take the dose prescribed. If you miss a dose, don’t take extra medicine to make up for it. If the medicine does not seem to be working or side effects are too difficult to handle, talk to the prescribing healthcare provider about changing the dose or switching to a new medication. 

2.  Tell your healthcare provider about all your medical conditions and medications

Because of the risk of side effects, you should tell your healthcare provider about:

• Any physical conditions you may have, particularly heart, circulation, blood pressure, pancreas, kidney, or urinary tract problems
• All medications you are currently taking and
• All over-the-counter medications, supplements, and herbal remedies you take

Always talk to a doctor, pharmacist, or another healthcare professional, if you experience any side effects when taking Jardiance.

3.  Monitor blood sugar

Jardiance is often prescribed as a secondary therapy along with other diabetes medications including insulin, metformin, pioglitazone, or sulfonylurea. Jardiance, particularly when combined with other diabetes medications, can cause dangerously low blood sugar. Your healthcare provider may ask you to regularly monitor your blood sugar. You should also be vigilant for signs of low blood sugar such as fast heartbeat, pale skin, fatigue, anxiety, sweating, shakiness, irritability, confusion, or hunger. Take a fast source of sugar and possibly seek medical advice.   

4.  Pay attention to blood pressure

Jardiance has effects similar to a diuretic, so it can reduce blood volume and blood pressure. Be on the lookout for symptoms of low blood pressure such as dizziness when standing up, fainting, lightheadedness, drowsiness, blurred vision, nausea, and cold, clammy skin. If you’re having problems with low blood pressure when taking Jardiance, it may help to purchase a blood pressure device and regularly monitor and record your blood pressure. 

Resources:

• Clinical Review Report: Empagliflozin (Jardiance), Canadian Agency for Drugs and Technologies in Health
• Empagliflozin, StatPearls
• Empagliflozin compound information, National Library of Medicine
• Fournier Gangrene, National Organization for Rare Disorders
• Hypoglycemia symptoms, EndocrineWeb
• Jardiance, Epocrates
• Jardiance Information Sheet, Shire US
• Jardiance Medication Guide, Boehringer Ingelheim