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Canadian Med Center

Infections Due to Jardiance Usage

Tuesday 12 March 2024
Infections
13 minute(s) read
By Kiran Altaf

Table of Contents

I. What is Jardiance?

II. Urinary Tract Infection (UTI)

III. Yeast Infection

IV. Fournier Gangrene

V. Conclusion

While Jardiance (empagliflozin) is an effective medication for treating type 2 diabetes, heart failure, and chronic kidney disease, it comes with some risks that patients should be aware of. One of the most concerning potential side effects of Jardiance is an increased susceptibility to certain infections. [1]

In this article, we'll dive into the infections linked to Jardiance usage. We'll discuss the risks, symptoms, and treatment of urinary tract infections, yeast infections, and Fournier gangrene.

What is Jardiance?

Jardiance (empagliflozin) is a medication used to help manage type 2 diabetes, heart failure, and chronic kidney disease. It belongs to a class of drugs known as sodium-glucose co-transporter 2 (SGLT2) inhibitors. These work differently than other diabetes drugs. Instead of directly affecting insulin levels, Jardiance inhibits the SGLT2 protein found in the kidneys. [1]

Normally, the kidneys filter waste and excess fluid from the blood while reabsorbing glucose and other necessary substances back into the body. However, people with diabetes already have high blood sugar. Jardiance prevents the kidneys from reabsorbing glucose, which is excreted in the urine instead. This helps lower blood sugar levels. [1]

Because Jardiance releases more glucose in the urine, it can increase the risk of infections like

  • Urinary tract infections (UTIs)
  • Yeast infections
  • Fournier gangrene [2]

If you experience any concerning symptoms, contact your doctor right away. Most infections from Jardiance are minor and treatable with medication, but untreated infections can become severe.

Urinary Tract Infection (UTI)

A woman holding her abdomen and hunched in pain

A urinary tract infection (UTI) is a common bacterial infection that affects the urinary system. Bacteria from the skin or rectum enter the urethra and go up to the bladder, kidneys, and other parts of the urinary tract, causing infection and inflammation. [3]

The good news is that UTIs are easily treatable if caught early. However, if left untreated, the infection can spread further into your kidneys and cause a more serious kidney infection. That's why it's important to recognize the signs of a UTI and see your doctor immediately for an accurate diagnosis and treatment. [3]

Risk Factors

UTIs can affect anyone, but certain individuals may be at a higher risk. Understanding these risk factors can help you proactively prevent UTIs and maintain good urinary health.

  • Women are more prone to UTIs due to their anatomy. The female urethra is shorter and located closer to the rectum, making it easier for bacteria to enter the urinary tract.
  • A previous UTI can make you more likely to experience another one. Taking preventive measures can help reduce the recurrence of UTIs.
  • Sexual intercourse can introduce bacteria into the urinary tract, especially in females. Urinating before and after sexual activity, as well as maintaining proper hygiene, can help minimize the risk.
  • Menopause: The hormonal changes during menopause can decrease estrogen levels, resulting in changes to the urinary tract. This can make postmenopausal women more susceptible to UTIs. 
  • Pregnancy: Hormonal changes and increased pressure on the bladder during pregnancy can make women more vulnerable to UTIs. Regular prenatal care and practicing good hygiene are essential during this time.
  • Older adults and younger children: Age can also be a risk factor for UTIs. Older adults may have weakened immune systems, while children may not have developed proper hygiene habits yet. Proper care and attention are crucial for these age groups.
  • Poor hygiene: Not maintaining proper hygiene, such as wiping from front to back after using the toilet, can increase the risk of UTIs. Educating yourself and practicing good hygiene habits to reduce the likelihood of infection is important. [3]
  • People diagnosed with diabetes: Individuals with diabetes are more susceptible to infections, including UTIs. Proper management of diabetes and regular monitoring can help reduce the risk. [4]

Symptoms

Symptoms of a urinary tract infection can vary depending on its severity and progression. In the early stages, a UTI may present as a bladder infection, but if left untreated or more severe, it can develop into a kidney infection. [3]

When it comes to a bladder infection, there are several symptoms to be aware of. You may experience:

  • Pain or a burning sensation when urinating
  • A frequent urge to urinate even when your bladder is empty
  • Bloody urine
  • Pressure or cramping in the groin or lower abdomen [3]

On the other hand, if the infection progresses into a kidney infection, the symptoms may become more pronounced. You may develop:

  • Fever and chills
  • Lower back pain or pain on the side of your back
  • Nausea or vomiting [3]

Awareness of these symptoms is important, as they can help you identify a potential UTI and seek appropriate medical attention. Remember, early detection and prompt treatment can help prevent the UTI from worsening and causing more severe complications.

Jardiance and UTIs

Urinary tract infections are an unfortunate potential side effect of taking Jardiance. The reasons behind this increased risk stem from both the effects of Jardiance itself as well as the underlying diabetes. [2]

Those living with diabetes often find themselves more prone to UTIs for a couple of reasons.

  • Neuropathy: High blood sugar over time can damage the nerves that control bladder function, a condition called diabetic neuropathy. This makes it difficult to fully empty your bladder, allowing bacteria to grow and infect the urinary tract.
  • Weakened immune system: Diabetes weakens the immune system by reducing natural antibiotic levels in the body. With fewer defenses against infection, bacteria can more easily spread and cause a UTI. [4]

Jardiance comes into play by causing excess sugar to be expelled in the urine. This sugary urine creates the perfect environment for bacteria to thrive and multiply. So, Jardiance provides the ideal breeding ground for the bacteria that cause urinary tract infections. [2]

The good news is that staying hydrated and maintaining good bladder hygiene can go a long way towards preventing UTIs in those taking Jardiance. While frustrating, UTIs are treatable conditions, especially when caught early. [4]

Treatment and Prevention

Treatment for UTIs typically involves a course of oral antibiotics to eliminate the infection. Your doctor will determine the appropriate type of antibiotic based on factors like your medical history, other medications you’re taking, and the severity of your symptoms. [4]

Most UTI symptoms pass within 3 to 5 days of starting antibiotic treatment. However, to completely cure the infection, take the full course of antibiotics as prescribed. [4]

Prevention is key when it comes to UTIs. Here are some simple yet effective tips to help reduce your risk:

  • Stay Hydrated: Drinking an ample amount of water throughout the day can help flush out bacteria from your urinary tract.
  • Urinate After Intercourse: Emptying your bladder after sexual activity can help prevent the spread of bacteria.
  • Practice Proper Hygiene: For women, wiping from front to back after using the restroom can prevent the introduction of bacteria into the urinary tract. [4]

Yeast Infection

A woman clasping hands over waist

Yeast infections are caused by an overgrowth of a fungus called Candida. While yeast lives naturally in our bodies, certain circumstances can trigger excessive growth, resulting in infection. Women are especially prone to yeast infections in the vaginal area. [5]

Risk Factors

While anyone can develop a yeast infection, some people are more prone to them. Those at higher risk include:

  • People taking antibiotics, which can kill off healthy bacteria and allow yeast to flourish.
  • Those undergoing cancer treatments, which can compromise the immune system.
  • Anyone with a weakened immune system, such as from diabetes or HIV, is more susceptible.
  • Living in hot, humid climates can make yeast infections more likely due to increased sweating. [5]

Symptoms

Yeast infections can be uncomfortable and frustrating, but it's important to understand the different symptoms in men and women to identify them and get treatment.

  • Symptoms in women: Women often experience thick white or yellow vaginal discharge, intense itchiness, redness around the vagina, and a burning sensation. 
  • Symptoms in men: Men may notice redness, a scaly rash, or burning on the tip or underside of the penis. The rash can be quite painful or irritating. [5]

While yeast infections can be annoying, the good news is they are typically easily treated. If you notice any of the symptoms mentioned above, talk to your doctor. They can determine if it's truly a yeast infection and recommend appropriate treatment to relieve your discomfort. [5]

Jardiance and Yeast Infections

If you have diabetes, you may already know that you are more susceptible to certain infections, including yeast infections. And if you're one of the many people with diabetes who take Jardiance, it's important to be aware that this medication can further increase the risk of yeast infections.

Diabetes makes people more susceptible to yeast infections for several reasons:

  • A weakened immune system: Poorly controlled diabetes, often signaled by high blood sugar, inhibits the immune response. The excess sugar can suppress immune proteins that help immune cells locate and eliminate infections.
  • High sugar in the genital area: Too much sugar in the body gives yeast an ideal food source. Yeast can easily stick to skin cells and mucus glands, raising the risk of infection.
  • Previous infection: Once yeast establishes itself in an area, future infections are more likely. This is especially true for those struggling to manage their diabetes, as they tend to have recurring issues. [5]

In addition to these risk factors, Jardiance usage further increases the risk of yeast infections in people with diabetes. These medications release glucose in the urine, providing an additional food source for yeast to thrive in the genital area. [2]

The good news is yeast infections are typically easy to treat. See your doctor right away for an accurate diagnosis and treatment. They may prescribe antifungal medication, recommend better diabetes management, and suggest ways to prevent future infections.

Treatment and Prevention

To treat a yeast infection, your doctor will determine a treatment plan based on your overall health and the severity of the infection. Minor yeast infections can typically be cured easily if detected early.

  • Minor yeast infections of the vagina or penis can be treated with antifungal creams or medicated suppositories.
  • If you have a severe infection or a weak immune system, you may need to take an oral antifungal medication. [5]

Luckily, yeast infections can be prevented by a few lifestyle changes:

  • Wear cotton underwear: Breathable cotton underwear can help maintain a dry and airy environment, making it less conducive for yeast to thrive.
  • Keep the genital area dry and friction-free: Moisture and friction can create the perfect environment for yeast to grow. Make sure to dry the genital area thoroughly after bathing or swimming. 
  • Avoid hot tubs: Hot tubs and similar environments can be breeding grounds for bacteria and yeast. To reduce the risk of infection, avoid spending prolonged periods in hot tubs.
  • Avoid scented products: Scented soaps, bubble baths, and sprays may seem appealing, but they can disrupt the natural balance of bacteria in the genital area. Stick to mild, unscented products to minimize the chances of developing a yeast infection. [5]

Fournier Gangrene

Fournier gangrene is a rare yet serious bacterial infection that impacts the genital and rectal areas. While it may not be a common condition, it's important to understand the causes, symptoms, and treatment for this rapidly progressing infection. [6]

Fournier gangrene often starts when bacteria enter the body through a cut or wound around the genitals or rectum. These bacteria then quickly spread and destroy the soft tissues in these areas. Within days, the infection can advance, causing severe symptoms. That's why seeking emergency medical care right away is crucial. [6]

Around 95% of Fournier gangrene cases originate from an infection or injury in the genital area, including:

  • Urinary tract infections: Bacteria from a UTI can enter the soft tissues surrounding the urethra and spread.
  • Abscesses: An abscess in the genital area provides an entry point for bacteria to invade surrounding tissues.
  • Genital piercings: A piercing can introduce bacteria deep into the soft tissues, allowing for the rapid spread of infection. [6]

Risk Factors

While Fournier gangrene is considered rare, it is important to be aware of the factors that can increase the risk of developing this serious condition, particularly for males. Certain underlying health conditions can elevate the risk of Fournier gangrene, including:

  • Diabetes (present in 60% of Fournier gangrene cases)
  • Alcoholism
  • Liver cirrhosis
  • Systemic lupus erythematosus
  • Crohn disease
  • HIV infection
  • Morbid obesity [6]

Symptoms

The early symptoms of Fournier gangrene may seem mild at first but will worsen rapidly if left untreated. As the infection sets in, the symptoms become more severe, and visible changes appear. Common symptoms of Fournier gangrene include:

  • Fever
  • Tiredness
  • Fast heart rate
  • Low blood pressure
  • Severe genital pain
  • Blistering, redness, pus, and itchy skin in the genital area

If you notice any of these symptoms, especially genital pain along with fever, don't wait. See your doctor right away or go to the emergency room. Swift treatment with antibiotics and possibly surgery gives you the best chance of recovery. [6]

Jardiance and Fournier Gangrene

In 2018, the U.S. Food and Drug Administration (FDA) reported twelve cases of Fournier gangrene associated with SGLT2 inhibitor usage (such as Jardiance). [7]

In comparison, only 6 cases of Fournier gangrene were reported in patients taking other diabetes medications. This suggests an increased risk associated specifically with SGLT2 inhibitor usage. In all 12 cases linked to SGLT2 inhibitors, the medication was immediately discontinued, the patients were hospitalized, and they all underwent surgery for the infection. [7]

While having diabetes does increase the risk of developing Fournier gangrene, it is still considered a rare condition. The higher incidence seen with Jardiance and other SGLT2 inhibitors is likely due to the increased risk of genital infections. By causing sugar in urine, these medications create an environment conducive to bacterial growth in the genital region. [7]

If you are currently taking Jardiance or another SGLT2 inhibitor, it is important to be aware of potential signs of Fournier gangrene. If you notice any symptoms, seek medical care right away. Fournier gangrene requires prompt treatment, so early diagnosis and intervention are crucial. [7]

Treatment

To treat Fournier gangrene, timely and appropriate treatment is crucial as this condition can quickly become life-threatening. Due to the gradual onset of symptoms, diagnosis is often delayed, resulting in a mortality rate ranging from 20 to 40%. However, with proper intervention, the prognosis can be significantly improved. [6]

Treatment for Fournier gangrene typically involves the following key approaches:

  • Surgical debridement: When a CT scan detects gas in the affected area, immediate surgical intervention is necessary. This procedure involves thoroughly cleaning and removing all dead tissue to stop the spread of infection and promote healing.
  • Antibiotics: A combination of oral and intravenous antibiotics will be prescribed to combat the infection effectively. This dual approach helps to eradicate the bacteria causing the condition and prevent further complications. [6]

Conclusion

Jardiance stands as a valuable tool in the management of several conditions. However, it is important to remember that no treatment comes without potential risks.

Patients taking Jardiance have an increased risk of urinary tract infections, yeast infections, and, in rare cases, Fournier gangrene. These risks may seem alarming, but with open communication, patients and healthcare providers can work together to maximize the benefits of Jardiance while minimizing risks.

To learn more about different infections, visit our dedicated infection 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.