Common side effects include:

• Urinary tract infections (UTIs)
• Yeast infections
• Upper respiratory tract infections
• Increased urination
• Painful urination
• Increased cholesterol
• Joint pain
• Nausea
• Thirst
• Back pain
• Constipation
• Flu [7]

While most common side effects are minor, some adverse effects are more serious.

• Genital infections: Diabetes increases the risk of genital infections. This risk is further heightened when taking SGLT2 inhibitors, which can increase the chances of infection by up to 5 times. Germs, such as bacteria and fungi, thrive in body fluids with high sugar content. Since SGLT2 inhibitors increase glucose levels in urine, the risk of genital infections, such as yeast infections in the vagina or penis, also increases.

• Fournier’s Gangrene: While the risk is extremely low, recent reports have linked SGLT2 inhibitors to a serious genital infection called Fournier's Gangrene. This infection typically starts with redness or a sore in the genital or groin area, which spreads rapidly. If you notice any symptoms of Fournier's Gangrene, it is crucial to seek urgent medical attention. In most cases, discontinuing SGLT2 inhibitors has been the recommended course of action.

• Ketoacidosis: SGLT2 inhibitors can cause an increase in blood levels of ketones. Although rare, this can lead to a condition known as "diabetic ketoacidosis." While typically observed in individuals with type 1 diabetes, it can also occur in those with type 2 diabetes. If you notice a sweet smell on your breath, sweat, or urine or experience symptoms such as nausea, abdominal pain, rapid weight loss, or excessive thirst, it is important to contact your doctor immediately.

• Urinary tract infection (UTI): SGLT2 inhibitors increase the risk of UTIs. If left untreated, these infections can progress to life-threatening conditions such as blood and kidney infections. It is crucial to seek prompt medical attention if you suspect a UTI.

• Bladder cancer: Clinical studies have suggested a very slight risk of bladder cancer in patients taking Farxiga. However, it is challenging to determine whether this risk is due to the medication itself or the fact that individuals with diabetes already have a higher risk of developing bladder cancer. That being said, patients with active bladder cancer should not use this drug, and those with a history of bladder cancer should exercise caution when considering its use.

• Amputations: In 2017, the FDA added a black box warning to Invokana due to an increased risk of lower limb amputations. This warning was based on two clinical trials that found amputations occurred twice as often in individuals taking Invokana compared to those taking a placebo. The most common amputations were of the toe and mid-foot, but amputations above and below the knee also occurred.

• Kidney injury: In 2016, the FDA strengthened warnings on Invokana and Farxiga, indicating they may cause kidney injury. When the kidneys fail to function properly, harmful levels of waste can accumulate in the blood. Over two years, the FDA received 101 reports of kidney injury in patients using these drugs. Most cases occurred within the first month of starting treatment. [7]

Conclusion

SGLT2 inhibitors provide an important option for managing type 2 diabetes, chronic kidney disease, and cardiovascular disease. Multiple medications are available within this drug class, so you can work with your doctor to find the most appropriate one based on your medical needs. However, as with any drug, be sure to disclose your full medical history to your physician to avoid potential side effects or complications.

To learn more about diabetes, visit our dedicated diabetes blog.

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.