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How to avoid yeast infections on Jardiance?

Medically reviewed by Leigh Ann Anderson, PharmD Last updated on May 19, 2020.

Official Answer

by Drugs.com

Key Points

  • Both men and women are more susceptible to genital yeast (mycotic) infections when using Jardiance (empagliflozin). Yeast infections with Jardiance appear to be mild, treatable, and rarely lead to discontinuation of treatment.
  • You may not always be able to prevent a yeast infection, but treatment is usually very quick and effective. Keep your blood sugar levels in check. Lifestyle suggestions to moderate yeast infections include: choosing loose-fitting cotton garments instead of synthetic fabrics, keeping your genital area dry and maintaining good hygiene.
  • Jardiance is in a class of drugs known as sodium-glucose cotransporter-2 (SGLT-2) inhibitors. This entire class of drugs is associated with a higher incidence of gential yeast infections when compared to an inactive placebo, so these side effects are uncommon but not unexpected.

What is Jardiance used for?

Jardiance (empagliflozin) is a prescription drug used to help control glucose (blood sugar) in adult patients with type 2 diabetes. Jardiance is also approved by the FDA to lower the risk of cardiovascular (heart-related) death in adults with heart disease and type 2 diabetes.

Jardiance is given as an oral tablet once daily and is used in addition to diet and exercise. It can be added to other medicines for type 2 diabetes such as metformin, sulfonylureas, pioglitazone, and insulin as well as other heart medications like statins, beta blockers, ACE inhibitors, and diuretics. Jardiance, classified as an SGLT-2 inhibitor, is made by Boehringer Ingelheim Pharmaceuticals and Eli Lilly.

SGLT-2 inhibitors have been shown to be effective at lowering hemoglobin A1c levels, improving weight loss and lowering blood pressure in type 2 diabetes. They carry a low risk of hypoglycemia (low blood sugar levels) when used alone (as monotherapy).

SGLT-2  inhibitors come as single-ingredient products or combined with other diabetes medicines. Other single-ingredient FDA approved medications in the SGLT-2  inhibitor class include:

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

Why do yeast infections occur with Jardiance?

The mechanism of how SGLT-2 inhibitors work in type 2 diabetes may be responsible for how the yeast infection occurs.

SGLT-2 proteins are located in the renal tubules of the kidneys and are responsible for reabsorbing glucose back into the blood. Jardiance blocks the action of the SGLT-2 proteins. As a result, more glucose is excreted in the urine. Increased levels of glucose in the urine (glycosuria) can lead to these mycotic (yeast) infections.

Does Jardiance cause yeast infections in both women and men?

Yes, genital mycotic (yeast) infections have been reported by the manufacturer in both men and women. However, they occur more frequently in women.

Patients with a history of recurrent or chronic yeast infections may be at greater risk, too,

What do studies say about genital yeast infections with Jardiance?

The manufacturer assessed five placebo-controlled clinical trials as a whole (pooled analysis) to look at the incidence of genital yeast infections with Jardiance. Overall, the incidence of genital mycotic infections (also referred to as vaginal mycotic infection, vaginal infection, genital infection fungal, vulvovaginal candidiasis, and vulvitis in study analysis) was increased in patients treated with Jardiance compared to taking a placebo.

Table 1. Incidence of Genital Yeast (Mycotic) Infections with Jardiance

Treatment Group  Incidence (pooled analysis)
*Table adapted from manufacturer’s data
Placebo (995 patients) 0.9%
Jardiance 10 mg (999 patients) 4.1%
Jardiance 25 mg (977 patients) 3.7%

Most patients do not need to stop treatment due to the occurrence of a genital yeast infection. In patients treated with Jardiance 10 mg or 25 mg, only 0.2% of patients (2 out of 1,000) discontinued therapy. No patients stopped treatment in the placebo group.

Incidence in women  

In pooled Phase 3 studies of over 1,300 women, yeast infections of the vagina (vulvovaginitis) occurred in 5.4% (5.4 out of 100) of patients taking 10 mg daily of Jardiance, 6.4% of women taking the 25 mg strength, and in 1.5% of women using an inactive placebo.

Incidence in men

In men, yeast infection of penis (e.g., balanitis or balanoposthitis) may occur, especially in uncircumcised males and patients with chronic and recurrent infections.

In pooled Phase 3 data of over 1,600 men, yeast infections of the penis occurred in 3.1% (3.1 out of 100) of patients taking 10 mg daily dose of Jardiance, 1.6% of men taking the 25 mg strength, and in 0.4% of men using an inactive placebo.

Symptoms of Genital Yeast Infections

Genital yeast infections are one of the most common side effects linked with the use of Jardiance, even though the incidence is low. Diabetes itself may also increase the risk of having a yeast infection.

Recognizing when a yeast infection is occurring is important for early treatment and successful therapy. When you are prescribed Jardiance, be sure to talk to your doctor about what to do if you get symptoms of a yeast infection of the vagina or penis.

Your doctor may prescribe prescription medications or suggest you use an over-the-counter (OTC) antifungal medicine. Be sure to contact your doctor right away if your symptoms do not improve with treatment. 

Symptoms of a vaginal yeast infection in women (vulvovaginitis, candidiasis):

  • vaginal itching
  • vaginal odor
  • white or yellowish discharge that may be lumpy or look like cottage cheese
  • vaginal burning discomfort or burning while urinating
  • painful sexual intercourse

Symptom of a yeast infection of the penis in men (balanitis or balanoposthitis):

  • redness, itching, or swelling of the penis
  • rash or sores on the penis
  • foul smelling discharge from the penis
  • pain in the skin around penis
  • tight, shiny skin on the head of your penis
  • painful urination or not being able to urinate
  • swollen glands near your groin

Some men who are not circumcised may have swelling of the penis that makes it difficult to pull back the skin around the tip of the penis. Balanitis is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. An allergy to condoms or spermicides may also worsen balanitis caused by yeast.

How can I prevent or treat yeast infections with Jardiance?

When yeast infections occur, they usually respond well to treatment. Up to 90% of vaginal yeast infections are cured within 2 weeks or less, often within a few days. Most cases of balanitis respond to treatment within three to five days. Conventional oral prescription or even over-the-counter topical antifungal treatment are usually effective.

The yeast, Candida albicans, is the most common cause of vaginal candidiasis.

Common treatments include:

  • Over-the-counter or prescription topical azole antifungals such as clotrimazole (Lotrimin, Mycelex), miconazole (Monistat 3), terconazole (Terazol)
  • prescription oral fluconazole (Diflucan).

Longer treatment regimens may be needed if your symptoms are severe, or you have frequent or chronic yeast infections. Your doctor might also choose to switch you to a different class of diabetes medication, if required, but this is usually not necessary.

Sexual contact can pass an infection back and forth between partners. If this occurs, you and your partner will need treatment at the same time to prevent further infections.

Lifestyle changes to help avoid a yeast infection

Lifestyle changes may not prevent yeast infections with Jardiance, but they can help to make life more comfortable and hasten your improvement.

  • Wear breathable, loose fitting fabrics, and choose cotton over synthetic fabrics. In women, avoid tight-fitting pantyhose.
  • Follow proper hygiene and try to stay dry as possible. Change clothes quickly after swimming or working out.
  • Avoid condoms with spermicide, which may aggravate yeast infections.
  • Do not use antibiotics for colds or other viral infections, which may increase the risk for yeast infections
  • In women: avoid douching, scented sanitary products and bubble baths, which can alter the pH of the vagina and increase the risk of yeast infections.
  • Avoid hot tubs and very hot baths.

Bottom Line

Maintaining control of your blood sugar levels can help you to avoid worsening yeast infections in type 2 diabetes. Genital yeast infections are not common, but can occur with use of Jardiance. Most infections are mild, easily treatable, and improve within a few days after medication is started.

Wear loose-fitting, breathable cotton clothes and change out of wet or moist clothes as quickly as possible.

Speak with your doctor about the side effect of genital yeast infections before you are prescribed Jardiance. Learn to recognize the symptoms of a yeast infection and have an action plan in place with your doctor.

This is not all the information you need to know about Jardiance for safe and effective use. Review the full Jardiance information here, and speak to your health care provider if you have questions or concerns.

References
  • Levine MJ. Empagliflozin for Type 2 Diabetes Mellitus: An Overview of Phase 3 Clinical Trials. Curr Diabetes Rev. 2017;13(4):405‐423. doi:10.2174/1573399812666160613113556
  • Jardiance [package insert].  Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT Accessed May 19, 2020 at https://docs.boehringer-ingelheim.com/Prescribing%20Information/PIs/Jardiance/jardiance.pdf
  • Jardiance [Medication Guide]. Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield, CT Accessed May 18, 2020.
  • Tsai A. How to spot and prevent yeast infections. Diabetes Forecast. Jan. 2-17. Accessed May 19, 2020 at http://www.diabetesforecast.org/2017/jan-feb/how-to-spot-and-prevent-yeast.html

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