SGLT2 medicines for heart failure
Jardiance (empagliflozin) and Farxiga (dapagliflozin)
Jardiance (empagliflozin) and Farxiga (dapagliflozin) are alternatives for heart failure across ejection fractions (EF), with or without diabetes. Usual HF dose: 10 mg once daily, with or without food. Take only one. [12] [13] [14] [15]
What benefit was seen?
Medicine or placebo was added to usual care. Outcomes: cardiovascular death/HF admission; dapagliflozin also counted urgent HF visits needing IV treatment. [1] [2] [3] [4]
| Trial / population / time | Medicine | Placebo |
|---|---|---|
| Jardiance: EMPEROR-Reduced EF ≤40%; 16 months | 361/1,863 (19.4%) | 462/1,867 (24.7%) [1] |
| Farxiga: DAPA-HF EF ≤40%; 18.2 months | 386/2,373 (16.3%) | 502/2,371 (21.2%) [2] |
| Jardiance: EMPEROR-Preserved EF >40%; 26.2 months | 415/2,997 (13.8%) | 511/2,991 (17.1%) [3] |
| Farxiga: DELIVER EF >40%; 2.3 years | 512/3,131 (16.4%) | 610/3,132 (19.5%) [4] |
About 3–5 fewer people per 100 had these outcomes, mainly fewer HF hospital visits. These are not yearly risks or direct drug comparisons; not every trial proved longer survival. [1] [2] [3] [4]
Commonly reported problems
More urination, genital yeast infection and dizziness from fluid loss can occur. Urinary and genital infections differ. [12] [13]
| Reported event | Jardiance | Placebo |
|---|---|---|
| Genital infection | 1.7% | 0.6% [5] |
| Urinary tract infection | 4.9% | 4.5% [5] |
| Fluid depletion | 10.6% | 9.9% [5] |
Collected through 7 days after stopping; median 16 months. Farxiga HF trials did not collect every mild infection, preventing direct comparison. Report itching, discharge, burning urination or persistent dizziness. [5] [2] [8]
How often did people stop?
| Definition / trial | Medicine | Placebo |
|---|---|---|
| Any reason except death DAPA-HF, 18.2 months | 249/2,373 (10.5%) | 258/2,371 (10.9%) [2] |
| Any reason except death EMPEROR-Reduced, 16 months | 303/1,863 (16.3%) | 335/1,863 (18.0%) [1] |
| Adverse event: DAPA-HF | 111/2,368 (4.7%) | 116/2,368 (4.9%) [2] [6] |
Reported problems need not be drug-caused. A Korean cohort estimated 7.5% stopped by one year for various reasons; this is not a US or drug-specific prediction. [2] [1] [11]
Daily, pause and urgent-care plan
Before starting: kidney tests and water-pill review. Take the prescribed 10 mg daily. Do not adjust insulin yourself. [12] [13]
Pause: hold during vomiting, dehydration or inability to eat/drink and contact your team. Hold at least three days before surgery/prolonged fasting. Restart when your team confirms you are stable and eating/drinking. [12] [13]
Urgent: stop and seek care for nausea/vomiting with belly pain, unusual weakness or difficult breathing. Dangerous acid buildup can occur without high glucose. Genital/perineal pain or swelling with fever also needs urgent care. Discuss type 1 diabetes or a ketogenic diet before use. Call if pregnant and avoid breastfeeding. [12] [13]
What might I pay out of pocket?
| Payment route | Price and conditions |
|---|---|
| GoodRx coupon/cash: 10 mg ×30 / 30 days | Generic dapagliflozin $20.15; Jardiance $249 cash offer. Pharmacy/eligibility vary. [16] [18] [19] |
| Blueberry cash | Generic dapagliflozin 10 mg: $25.30 advertised 90-day supply. Confirm quantity and all fees. No public Jardiance quote verified. [20] [21] |
| Typical insured benchmark | Employer-plan tier 1/2/3 averages: $12/$40/$71; not either drug’s copay (KFF 2025, plans with 3+ tiers). [22] |
Medicare 2026: plan-specific costs; maximum deductible $615 and $2,100 yearly Part D out-of-pocket cap, excluding premiums. Extra Help, if eligible: generally at most $5.10 generic/$12.65 brand per covered prescription. Cash outside Part D does not count toward its deductible/cap. [24] [25]