In 2013, the U.S. Food and Drug Administration (FDA) approved the first medication in a new class of drugs to fight type 2 diabetes mellitus, known as SGLT2 inhibitors. Since then several other drugs in the class have been approved to help lower blood sugar in people with diabetes.
The most popular SGLT2 inhibitors today are:
- Farxiga/Forxiga (dapagliflozin) – made by AstraZeneca
- Invokana (canagliflozin) – made by Janssen Pharmaceuticals, a division of Johnson & Johnson
- Jardiance (empagliflozin) – made by Boehringer Ingelheim
Together, these three drugs (and combination drugs like Invokamet) accounted for more than $3.4 billion in sales in 2017. According to the pharmaceutical companies’ most recent annual reports, sales of both Farxiga and Jardiance increased significantly over the previous year, while Invokana’s sales decreased somewhat.
Given the growth in the use of all three SGLT2 inhibitors over the last five years, we’ve put together a comparison between the most popular SGLT2 inhibitors to help you understand the relative risks of each. While the action of the mechanism is the same – they all block the sodium-glucose co-transporter 2 (SGLT2) protein – there are some differences between each of these diabetes medicines. In particular, they differ to some degree in terms of side effects, drug interactions, and contraindications (i.e., who should avoid taking the drug).
Important: This comparison should not be considered as medical advice. Talk to your doctor or pharmacist if you have any questions about how these diabetes drugs could affect you.
How Jardiance, Invokana, and Farxiga Are Similar
All three SGLT2 inhibitors are similar in that they block the SGLT2 protein in the kidneys. Doing so prevents blood glucose from being reabsorbed by the kidneys, reducing the overall amount of sugar in the bloodstream. Instead, sugar is expelled from the body in urine through a process called osmotic diuresis. Unfortunately, the diuretic effects of Invokana, Farxiga and Jardiance can lead to problems associated with dehydration, including thirst, low blood pressure, lightheadedness, dizziness, and fainting.
Perhaps the most serious side effect that can be caused by Farxiga, Invokana, and Jardiance is an increase in acidic bodies (ketones) in the blood, known as diabetic ketoacidosis. This deadly condition requires immediate hospitalization, as it can lead to coma or death if not treated right away.
SGLT2 inhibitors can also cause kidney problems, especially in people who already have kidney disease or reduced renal function. The drug labels for all three medications warn against people taking Farxiga, Invokana, or Jardiance if they have renal impairment, end-stage renal disease, or are on dialysis.
All three of these drugs can also put patients at risk of low blood sugar, a condition known as hypoglycemia. This might seem obvious, given that the purpose of SGLT2 inhibitors is to decrease blood sugar levels, but many people may not realize this is a possible side effect. Hypoglycemia is more likely in people who take another diabetes drug meant to reduce blood sugar, such as metformin (which decreases glucose production by the liver) or insulin (which helps the body use sugar in the blood).
All SGLT2 inhibitors also have a small risk of allergic reaction (also called hypersensitivity). These reactions can come in various forms, including hives or red splotches on the skin, rash, itching, and swelling of the face, lips, throat, or tongue – which could lead to difficulty breathing. Anyone who experiences an allergic reaction to Farxiga, Invokana, or Jardiance should stop taking the drug immediately and contact their doctor to discuss potential alternatives.
Finally, all three diabetes drugs also include the increased risk of certain types of infections. The most serious is a form of flesh-eating bacteria (necrotizing fasciitis) that can attack the genitals and surrounding area, potentially leading to disfigurement or even death. Less serious infections, such as yeast infections and urinary tract infections, are also more common – but if left untreated, they could develop into more severe problems, such as urosepsis, a life-threatening blood infection.
Differences Between Jardiance, Invokana, and Farxiga
While Farxiga, Invokana, and Jardiance all block the SGLT2 protein, they each have a slightly different chemical structure. These variations can lead to side effects seen in patients who take one of these diabetes medications but not in others.
Invokana has a significantly higher risk of leading to lower-leg, toe, and foot amputations – almost double than typically seen for people with type 2 diabetes. Neither Farxiga nor Jardiance carries the same warnings about amputation as Invokana, though some researchers have called for additional studies.
Foremost is the type of pain that patients may experience as a side effect. Invokana has been associated in clinical trials with abdominal pain, while Farxiga has been associated with back pain. Jardiance, on the other hand, has been linked to certain types of joint pain and inflammation.
Another difference is the presence of minerals or other substances in the blood. Invokana, in particular, can cause patients to have high levels of both potassium and magnesium. Similarly, Farxiga can cause patients to have elevated levels of phosphorus. While all of these minerals are essential to the proper function of the body, they can cause problems when levels become too high.
Some patients who take Invokana have experienced symptoms related to overall weakness or tiredness. This includes fatigue and a loss of energy or strength. Invokana can also cause a higher chance of bone fractures, due to mineral depletion in the bones.
Farxiga can cause a higher risk of developing the common cold and the flu. Jardiance can lead to a higher risk of respiratory tract infection.
Summary: Farxiga vs Invokana vs Jardiance
|Brand Name(s)||Unique Side Effects|
Lawsuits Over SGLT2 Inhibitors
Thousands of lawsuits have been filed against pharmaceutical companies over the dangerous complications of SGLT2 inhibitors. Federal lawsuits involving Invokana and Farxiga have been consolidated in United States District Courts using multidistrict litigation to help facilitate the working of those cases. As of August 2018, there were more than 1,000 active Invokana lawsuits in the District of New Jersey, and about 50 active Farxiga lawsuits in the Southern District of New York.