Jardiance vs Farxiga Side Effects: What Women Need to Know Before Choosing

What Are These Drugs and Why Do Women Get Prescribed Them?

Both empagliflozin (Jardiance) and dapagliflozin (Farxiga) block the SGLT2 transporter in the kidney, causing glucose to spill into urine instead of being reabsorbed into the bloodstream. The result is lower blood glucose, modest weight loss (roughly 2-3 kg on average), and a small reduction in blood pressure. Women are prescribed these drugs for type 2 diabetes, heart failure with reduced ejection fraction (HFrEF), and now, in Farxiga's case, chronic kidney disease.

Why This Comparison Matters More for Women

Women with type 2 diabetes carry a 44% higher relative risk of fatal coronary heart disease compared with men with the same diagnosis, which makes the cardiovascular benefit data from these trials directly relevant to your care decisions. Women also face sex-specific side effects, particularly genital infections, that men do not experience in the same way. And the pharmacokinetics differ: women tend to have lower total body water and different renal tubular function, which can affect drug exposure.

Hormone status matters too. Estrogen influences glycosuria threshold and vaginal microbiome composition, meaning your risk profile for yeast infections and UTIs changes depending on whether you are premenopausal, perimenopausal, or postmenopausal.

Side-Effect Profiles: Where They Overlap and Where They Differ

No published randomized head-to-head trial has compared empagliflozin directly against dapagliflozin for side-effect frequency. The comparisons below draw on the individual key trials and their female-specific subgroups, plus published meta-analyses of the SGLT2 inhibitor class. Read those limitations before making clinical decisions.

Genital Mycotic Infections

This is the side effect women ask about most. The excess glucose in the urine feeds Candida growth in the vulvovaginal area. Across large trials, genital mycotic infections occur in roughly 10-15% of women on SGLT2 inhibitors, compared with 3-4% on placebo. Most episodes are mild and respond to a single dose of fluconazole, but recurrence is common while you remain on the drug.

Postmenopausal women are at higher baseline risk because estrogen deficiency already alters the vaginal microbiome and reduces lactobacilli dominance. If you are already managing genitourinary syndrome of menopause (GSM) or recurrent yeast infections, tell your prescriber before starting either drug.

Neither empagliflozin nor dapagliflozin appears to carry a meaningfully higher genital infection rate than the other based on current data.

Urinary Tract Infections

UTI risk is modestly elevated on both drugs. The EMPA-REG OUTCOME trial reported similar UTI rates between empagliflozin and placebo in the overall population, but women consistently show higher baseline UTI rates in all T2D trials regardless of drug assignment.

Dapagliflozin shows a slight signal for UTI elevation in some pooled analyses, though this has not translated into a definitive class difference in major trials. The DAPA-HF trial did not find a statistically significant increase in serious UTIs, but routine urinary symptoms were more common on active drug. If you have recurrent UTIs or a history of pyelonephritis, discuss this carefully with your clinician.

Volume Depletion and Low Blood Pressure

SGLT2 inhibitors act as osmotic diuretics. The result is a modest reduction in plasma volume, which lowers systolic blood pressure by approximately 3-4 mmHg on average. For many women, this is welcome news, especially in the context of heart failure or hypertension. For women on ACE inhibitors, ARBs, or diuretics, it raises the risk of symptomatic hypotension, dizziness, and falls.

Older postmenopausal women, who already have higher fall risk, need close monitoring in the first few weeks of either drug. Women who are underweight, have poor oral intake, or are fasting for any reason (including religious or surgical fasting) should hold the dose and contact their clinician.

Diabetic Ketoacidosis

DKA with SGLT2 inhibitors can occur even when blood glucose is in the normal range ("euglycemic DKA"), making it easy to miss. Women with type 1 diabetes (for whom these drugs are generally off-label), PCOS patients who are under-insulinized, and women who fast or restrict carbohydrates dramatically face higher risk. The FDA added a black-box warning for DKA in 2015. Both drugs carry this warning equally.

Symptoms include nausea, vomiting, abdominal pain, and fatigue, and they can appear with only mildly elevated glucose. Any woman on either drug who develops these symptoms should seek emergency evaluation.

Lower-Limb Amputation (Farxiga-Specific Signal)

Canagliflozin (a different SGLT2 inhibitor, not Farxiga or Jardiance) carried an FDA black-box warning for amputation risk following the CANVAS trial. Neither empagliflozin nor dapagliflozin has shown this signal in their major trials. The EMPA-REG OUTCOME trial and DAPA-HF did not find excess amputation risk. Still, any woman with peripheral artery disease, active foot ulcers, or neuropathy should flag this history before starting any SGLT2 inhibitor.

Bone Fracture Risk

Dapagliflozin and canagliflozin have shown some fracture signals in observational data, though the DECLARE-TIMI 58 trial for dapagliflozin did not demonstrate a statistically significant increase in fracture rates. Empagliflozin has not shown a fracture signal in EMPA-REG OUTCOME data.

For postmenopausal women who already have osteopenia or osteoporosis, this is worth discussing. Bone mineral density declines in the years following menopause, and adding any agent with even a theoretical fracture risk deserves a conversation with your clinician. A baseline DEXA scan is reasonable if you are postmenopausal and starting one of these drugs.

Cardiovascular Benefits: Which Drug for Which Condition?

The two drugs share a drug class but have different primary evidence bases. Choosing between them is often less about side effects and more about which cardiovascular or renal benefit best fits your diagnosis.

Jardiance for Established Cardiovascular Disease

The EMPA-REG OUTCOME trial enrolled 7,020 adults with type 2 diabetes and established cardiovascular disease. Empagliflozin produced a 38% relative reduction in cardiovascular death compared with placebo. This was a striking and unexpected result at the time of publication in 2015. The benefit appeared within months of starting the drug, suggesting it was driven by hemodynamic effects rather than atherosclerosis regression.

Women made up approximately 29% of the EMPA-REG OUTCOME trial population, a common enrollment gap that limits certainty about sex-specific benefit magnitude. The direction of benefit was consistent in female subgroups, but the trial was not powered to confirm this independently.

Farxiga for Heart Failure

The DAPA-HF trial enrolled 4,744 patients with HFrEF (ejection fraction ≤40%), including individuals without diabetes. Dapagliflozin produced a 26% reduction in the composite of worsening heart failure or cardiovascular death compared with placebo. This was the first large trial to show an SGLT2 inhibitor benefit in HF patients who do not have T2D.

Women represented only 23% of DAPA-HF participants, another evidence gap to flag honestly. Heart failure with preserved ejection fraction (HFpEF) is more common in women than in men, and HFpEF was not the primary focus of DAPA-HF. The subsequent DELIVER trial for dapagliflozin in HFpEF enrolled a larger proportion of women and showed a benefit in that population too, but that trial had different enrollment criteria.

Farxiga's Expanded Kidney Disease Indication

In 2021, the FDA approved dapagliflozin for chronic kidney disease based on the DAPA-CKD trial. This makes Farxiga the preferred option if your primary diagnosis is CKD rather than T2D or HF. Empagliflozin received a similar CKD indication based on the EMPA-KIDNEY trial in 2023.

How These Drugs Affect Women Across Life Stages

Reproductive Years and PCOS

Women with PCOS have a higher prevalence of insulin resistance and type 2 diabetes at younger ages. SGLT2 inhibitors are not a standard PCOS treatment, and they are not approved for this indication. Small studies suggest modest improvements in metabolic markers with dapagliflozin in PCOS, but the data are preliminary and drawn from trials with fewer than 100 participants. The evidence is thin here, and using either drug off-label for PCOS alone would be extrapolating beyond current evidence.

If you have PCOS and are prescribed either drug for T2D, the weight loss benefit of 2-3 kg may modestly improve menstrual regularity and androgen levels, but this has not been studied directly in large trials.

Perimenopause and Menopause

Perimenopause brings rising insulin resistance as estrogen levels decline. Women in their late 40s and early 50s are at elevated risk of developing type 2 diabetes, and many clinicians are now prescribing SGLT2 inhibitors to this age group. The genital yeast infection risk is higher in this group for the reasons already described. The modest blood pressure reduction may be beneficial if you are also managing menopause-related cardiovascular risk.

Bone health deserves specific attention in postmenopausal women considering Farxiga, given the observational fracture signals mentioned above. Your prescriber should know your current bone density status.

Trying to Conceive

Neither drug is appropriate if you are actively trying to conceive. Both should be stopped before a planned pregnancy, with the timing guided by your diabetes management team. Insulin remains the standard of care for blood glucose control during pregnancy.

Pregnancy, Lactation, and Contraception

Both empagliflozin and dapagliflozin are contraindicated during the second and third trimesters of pregnancy. Animal studies show fetal kidney development abnormalities with SGLT2 inhibitors when exposure occurs during nephrogenesis, which in humans continues through approximately 36 weeks of gestation. First-trimester human safety data are limited, and no large prospective studies have been conducted in pregnant women.

The FDA label for empagliflozin states: "Advise females of reproductive potential to use effective contraception during treatment." The same language appears in the dapagliflozin label.

Lactation

There are no adequate human studies on transfer of empagliflozin or dapagliflozin into breast milk. Animal data show both drugs are present in milk. Because of the potential for serious adverse effects in nursing infants, including effects on the developing kidney, both drugs are not recommended during breastfeeding. Women who are postpartum and managing T2D should discuss insulin or other agents with their clinician until they wean.

Contraception Requirement

All women of reproductive age taking Jardiance or Farxiga should use reliable contraception. This is not a soft recommendation. Unplanned pregnancy while on either drug risks fetal kidney damage during a period when you may not yet know you are pregnant. If you are sexually active and not planning pregnancy, discuss long-acting reversible contraception (an IUD or implant) with your prescriber.

Who This Is Right For (and Who Should Think Twice)

Strong candidates for Jardiance

• Women with T2D and established cardiovascular disease, particularly those with atherosclerotic CVD
• Women who need modest blood pressure reduction alongside glucose lowering
• Women in perimenopause or postmenopause with high cardiovascular risk who have no history of recurrent genital infections

Strong candidates for Farxiga

• Women with T2D and heart failure with reduced ejection fraction
• Women with CKD (eGFR 25-75 mL/min/1.73m2) who need kidney-protective therapy
• Women with HFrEF who do not have T2D, where Farxiga is approved and empagliflozin's evidence is less established in that specific population

Women who should think carefully before starting either drug

• Any woman who is pregnant, breastfeeding, or not using contraception reliably
• Women with recurrent vulvovaginal candidiasis or recurrent UTIs
• Postmenopausal women with documented osteoporosis who are considering dapagliflozin specifically
• Women with a history of DKA or type 1 diabetes
• Women who follow very low-carbohydrate or ketogenic diets (elevated DKA risk)
• Women with active genital infections at the time of prescribing (treat and clear the infection first)

Practical Side-Effect Management for Women

Managing the genital yeast infection risk is the most common reason women stop these drugs prematurely. A few evidence-informed strategies can reduce this:

• Keep the genital area clean and dry; avoid tight synthetic underwear
• Discuss prophylactic fluconazole 150 mg monthly with your clinician if you have had more than two yeast infections per year at baseline
• Monitor for early symptoms and treat promptly rather than waiting
• If you develop a second yeast infection on the drug within three months, reassess whether continuing is the right choice

For UTI prevention, stay well hydrated, void after intercourse, and report any symptoms early. Upper tract infections (pyelonephritis) require immediate evaluation and possible drug interruption.

For volume depletion symptoms (lightheadedness on standing, excessive thirst, dry mouth), hold the drug during illness with reduced oral intake and contact your clinician. Both Jardiance and Farxiga should typically be held 3-4 days before any planned surgery.

Dosing Comparison at a Glance

| Feature | Jardiance (empagliflozin) | Farxiga (dapagliflozin) | |---|---|---| | Starting dose (T2D) | 10 mg once daily | 5 mg once daily | | Maximum dose (T2D) | 25 mg once daily | 10 mg once daily | | HF dose | 10 mg once daily | 10 mg once daily | | CKD dose | 10 mg once daily | 10 mg once daily | | Taken with food? | Either way | Either way | | eGFR cutoff for T2D glycemic benefit | <30 mL/min: not for glycemic use | <25 mL/min: not recommended | | Generic available? | No (as of 2025) | No (as of 2025) |

The Evidence Gap: What We Still Do Not Know in Women

Women have been historically underrepresented in cardiovascular outcomes trials. The EMPA-REG OUTCOME trial was approximately 29% female, and DAPA-HF was approximately 23% female. This means confidence intervals for benefit and harm in women are wider than in men. The direction of cardiovascular benefit appears consistent in female subgroups, but the magnitude has not been confirmed with the same statistical precision.

Sex-disaggregated data on side-effect frequency across the menstrual cycle, hormonal contraceptive use, and menopausal status are essentially absent from published trial reports. How estrogen-containing contraceptives or menopausal hormone therapy interact with SGLT2 inhibitor pharmacokinetics has not been formally studied. Women with PCOS who are hyperandrogenic may have different glycosuria thresholds than normoandrogenic women, but no trial has examined this.

These are real gaps. If your clinician references "the trial data" when discussing your risk, it is fair to ask whether the female subgroup analysis showed the same result.