SGLT2 medicines for heart failure
Jardiance (empagliflozin) and Farxiga (dapagliflozin)
Detailed source records support the one-page handout. Different trials, populations, follow-up periods and stopping definitions cannot be compared as a drug ranking.
Benefit interpretation and applicability
Keep the four trials separate. EMPEROR studies count CV death or first HF admission; DAPA-HF/DELIVER also count urgent IV-treated HF visits. EF above 40% includes mildly reduced and preserved EF, not uniformly normal pumping. DELIVER includes improved EF. Both agents work in HF with and without diabetes. The 2022 AHA/ACC/HFSA guideline recommends SGLT2 inhibition for symptomatic chronic HFrEF, Class I A; the 2023 ESC update recommends either agent for HFmrEF/HFpEF, Class I A. [1] [2] [3] [4] [14] [15]
Arithmetic absolute differences from exact event counts are approximately 5.4, 4.9, 3.2 and 3.1 percentage points, respectively. These do not replace hazard ratios. EMPEROR-Reduced CV death alone HR0.92 (95%CI0.75-1.12), EMPEROR-Preserved HR0.91 (0.76-1.09) and DELIVER HR0.88 (0.74-1.05) were not conclusive. DAPA-HF CV death was 227/2373 versus273/2371, HR0.82 (0.69-0.98). Do not call every composite a survival benefit. [1] [2] [3] [4] [14] [15]
Infections, denominators and collection windows
EMPEROR-Reduced Table3 strata sums: genital13+18=31 versus8+4=12; UTI39+52=91 versus34+49=83; volume94+103=197 versus100+84=184; hypotension85+91=176 versus91+72=163; acute renal failure77+98=175 versus94+98=192. Safety N936+927=1863 versus937+926=1863; randomized placebo N1867 must not be substituted. Window is through7days after last dose. Broad genital infection is not exclusively a fungal diagnosis. [5] [2] [6] [7] [8] [9]
DAPA-HF did not routinely collect every nonserious AE. On-treatment volume170/2368(7.2%) versus153/2368(6.5%) and renal141(6.0%) versus158(6.7%) were first dose through30days after last. Manuscript on/off-treatment counts are volume178(7.5%) versus162(6.8%), renal153(6.5%) versus170(7.2%). Do not mix these windows or borrow pooled diabetes-label infection percentages for HF. [5] [2] [6] [7] [8] [9]
DELIVER likewise selectively collected nonserious AEs. FDA Table24 serious UTI41/3126 versus37/3127; UTI permanent stops13 versus9; serious genital infection1 each; genital permanent stops3 versus0. Narrative percentages UTI5.2%/4.9% and genital0.9%/0.4% were not accompanied by exact numerators in retrieved tables and are not complete mild-infection incidence. EMPEROR-Preserved exhaustive frailty strata give genital67/2996(2.2%) versus22/2989(0.7%) and UTI297(9.9%) versus243(8.1%), median26.2months; precise post-dose window was not independently confirmed from that table. [5] [2] [6] [7] [8] [9]
Stopping definitions and the real-world boundary
The page compares nondeath all-reason medication stopping within each reduced-EF trial and separately shows DAPA-HF AE-related permanent stops111/2368 versus116/2368, collected through30days after last dose; the same counts appear in on/off-treatment analyses. Stopping treatment differs from leaving study follow-up; temporary sick-day holds differ from permanent stops. [2] [6] [1] [5] [3] [10] [7] [8] [11]
EMPEROR-Reduced Results gives335placebo stops(18.0%) immediately after stating that4of1867randomized placebo patients never received drug. The treated denominator1863 is therefore derived as1867−4;335/1867 would round17.9%, and must not be paired with the reported18.0%. [2] [6] [1] [5] [3] [10] [7] [8] [11]
Broader EMPEROR-Reduced safety AE discontinuation322/1863 versus328/1863 is not a subset of its303/1863 versus335/1863 nondeath disposition counts; exact fatal/nonfatal decomposition was not extracted. EMPEROR-Preserved broader AE discontinuation571/2996 versus551/2989 includes fatal events in the sponsor dossier, unlike the primary nondeath disposition measure696/2997 versus699/2991. Do not call either broad measure drug intolerance or subtract outcome deaths. DELIVER nondeath stops444/3131 versus442/3132; safety AE permanent stops182/3126 versus181/3127, first dose through30days after last. [2] [6] [1] [5] [3] [10] [7] [8] [11]
The Korean single-center retrospective cohort enrolled775 HF patients (70.6% diabetes), with mixed agents and EF. One-year stopping was a Kaplan-Meier estimate7.5%;85 total stops occurred across median567days follow-up, not all by one year. Persistent cessation included AE and other reasons, excluding temporary stops followed by resumption. There is no verified drug-specific US practice estimate here. The association with later events does not prove stopping caused them. [2] [6] [1] [5] [3] [10] [7] [8] [11]
Practical label limits
Both HF doses are10mg daily with/without food; these are alternatives, not combined therapy. Check kidney function and volume. Farxiga initiation below eGFR25 is not recommended; continuation rules differ. Jardiance trials did not initiate below eGFR20 or on dialysis. An early eGFR dip may stabilize; unexpected worsening warrants assessment. Serious hypersensitivity is a contraindication. Discuss pancreatic disease, pregnancy/breastfeeding and type1diabetes. [12] [13]
Both labels advise withholding at least3days before surgery/procedures involving prolonged fasting if possible, restarting when clinically stable and oral intake resumes. Vomiting, dehydration, reduced calorie intake, ketogenic diet, acute illness, surgery and reduced insulin can provoke ketoacidosis, sometimes with glucose below250mg/dL. Urgent symptom guidance must not wait for a high glucose reading. Hypoglycemia risk is greater with insulin/sulfonylureas. Genital/perineal pain, swelling or redness with fever/malaise may indicate a serious infection; fever/flank pain with UTI symptoms also needs urgent assessment. Jardiance foot wounds/infections deserve attention. [12] [13]
Price and coverage verification
All listed prices are USD and checked09/05/2026. GoodRx default geography wasZIP50307;10mg30tablets means30days at one daily. Generic dapagliflozin dosage table was$20.15 standard coupon; the advertised$9 option required paidCompanion and was not used. Jardiance$249 was a brand exclusive cash offer; the current GoodRx article says valid prescription regardless of insurance status. Do not transfer the commercial copay-card government exclusion to this cash offer without evidence. Conversely Farxiga$288 exclusive terms explicitly exclude government prescription coverage including Medicare even if paying cash. Taxes may apply; no separate retail dispensing/shipping fee was identified. [16] [17] [18] [19] [20] [21] [22] [23] [24] [25]
Blueberry direct public offer advertises generic dapagliflozin10mg$25.30/90days. The exact tablet quantity and whether fees are included were not confirmed; do not invent90tablets or a delivered total. Its public DrugOffer component is in https://blueberrypharmacy.com/assets/index-BsuGcA0m.js. No Jardiance/empagliflozin patient quote was verified in the public catalog; that does not prove unavailable supply. Blueberry serves listed states includingPA,OH,WV,NJ,DE,FL,IN; eligibility and shipping should be confirmed. [16] [17] [18] [19] [20] [21] [22] [23] [24] [25]
Manufacturer savings-card minima are not typical copays. No current drug-specific commercial copay distribution was verified directly from the manufacturer in this lookup. KFF tier averages are a general employer-plan survey benchmark only. Medicare2026 negotiated30-day-equivalent prices are$197 Jardiance and$178.50 Farxiga, not patient copays or cash prices. Arithmetic25% examples are$49.25/$44.63 only if the standard deductible is met, covered brand is used and cap not reached; actual plan and fees vary. ExtraHelp applies only when eligible; some beneficiaries pay less. Cash outsidePartD does not count toward the deductible/cap; premiums do not count toward the$2100cap. [16] [17] [18] [19] [20] [21] [22] [23] [24] [25]
Numerical records
EMPEROR-Reduced: Cardiovascular death or first HF admission
Symptomatic HF; LVEF at most 40%; with or without diabetes; Median 16 months. Randomized participants with first composite event; usual care in both arms; not an annual rate or a mortality-only result.
Empagliflozin: 361/1,863 (19.4%); Placebo: 462/1,867 (24.7%). [1]
DAPA-HF: Cardiovascular death or first worsening HF event (HF admission or urgent visit requiring IV therapy)
Symptomatic HF; LVEF at most 40%; with or without diabetes; Median 18.2 months. Randomized participants with first composite event; usual care in both arms; not an annual rate or a mortality-only result.
Dapagliflozin: 386/2,373 (16.3%); Placebo: 502/2,371 (21.2%). [2]
EMPEROR-Preserved: Cardiovascular death or first HF admission
Symptomatic HF; LVEF above 40%; with or without diabetes; Median 26.2 months. Randomized participants with first composite event; usual care in both arms; not an annual rate or a mortality-only result.
Empagliflozin: 415/2,997 (13.8%); Placebo: 511/2,991 (17.1%). [3]
DELIVER: Cardiovascular death or first worsening HF event (HF admission or urgent visit requiring IV therapy)
Symptomatic HF; LVEF above 40%; includes previously reduced EF that improved; with or without diabetes; Median 2.3 years. Randomized participants with first composite event; usual care in both arms; not an annual rate or a mortality-only result.
Dapagliflozin: 512/3,131 (16.4%); Placebo: 610/3,132 (19.5%). [4]
EMPEROR-Reduced: Genital infection
Safety population; sums of mutually exclusive diabetes/no-diabetes strata; Trial median 16 months; through 7 days after last dose. Reported adverse event, not proven treatment causation. Safety placebo N1863 differs from randomized N1867.
Empagliflozin: 31/1,863 (1.7%); Placebo: 12/1,863 (0.6%). [5]
EMPEROR-Reduced: Urinary tract infection
Safety population; sums of mutually exclusive diabetes/no-diabetes strata; Trial median 16 months; through 7 days after last dose. Reported adverse event, not proven treatment causation. Safety placebo N1863 differs from randomized N1867.
Empagliflozin: 91/1,863 (4.9%); Placebo: 83/1,863 (4.5%). [5]
EMPEROR-Reduced: Volume depletion
Safety population; sums of mutually exclusive diabetes/no-diabetes strata; Trial median 16 months; through 7 days after last dose. Reported adverse event, not proven treatment causation. Safety placebo N1863 differs from randomized N1867.
Empagliflozin: 197/1,863 (10.6%); Placebo: 184/1,863 (9.9%). [5]
EMPEROR-Reduced: Hypotension
Safety population; sums of mutually exclusive diabetes/no-diabetes strata; Trial median 16 months; through 7 days after last dose. Reported adverse event, not proven treatment causation. Safety placebo N1863 differs from randomized N1867.
Empagliflozin: 176/1,863 (9.4%); Placebo: 163/1,863 (8.7%). [5]
EMPEROR-Reduced: Acute renal failure
Safety population; sums of mutually exclusive diabetes/no-diabetes strata; Trial median 16 months; through 7 days after last dose. Reported adverse event, not proven treatment causation. Safety placebo N1863 differs from randomized N1867.
Empagliflozin: 175/1,863 (9.4%); Placebo: 192/1,863 (10.3%). [5]
DAPA-HF: Volume depletion
Safety population; Trial median 18.2 months; first dose through 30 days after last dose. On-treatment analysis; manuscript on/off-treatment counts differ. All mild infections were not routinely collected.
Dapagliflozin: 170/2,368 (7.2%); Placebo: 153/2,368 (6.5%). [6]
DAPA-HF: Renal adverse event
Safety population; Trial median 18.2 months; first dose through 30 days after last dose. On-treatment analysis; manuscript on/off-treatment counts differ. All mild infections were not routinely collected.
Dapagliflozin: 141/2,368 (6%); Placebo: 158/2,368 (6.7%). [6]
DAPA-HF: Premature stopping other than death
Trial disposition or safety population as specified; Median 18.2 months. Premature medication stopping for reasons other than death; temporary interruptions are separate.
Dapagliflozin: 249/2,373 (10.5%); Placebo: 258/2,371 (10.9%). [2]
DAPA-HF: AE-related permanent stopping
Trial disposition or safety population as specified; Median 18.2 months; first dose through 30 days after last dose. Permanent stopping because of a reported adverse event; safety population; does not establish drug causation.
Dapagliflozin: 111/2,368 (4.7%); Placebo: 116/2,368 (4.9%). [2] [6]
EMPEROR-Reduced: Premature stopping other than death
Patients who received study medication; placebo N1867 randomized minus4 never treated =1863; Median 16 months. Premature medication stopping for reasons other than death. Primary Results reports335(18.0%) after noting4placebo patients never received drug; treated placebo denominator1863 is derived from that disposition statement.
Empagliflozin: 303/1,863 (16.3%); Placebo: 335/1,863 (18%). [1]
EMPEROR-Reduced: AE-related permanent stopping
Trial disposition or safety population as specified; Median 16 months; through 7 days after last dose. Broader safety AE discontinuation, summed diabetes strata 147+175 versus 152+176. Not a subset of nondeath disposition stopping; do not label as drug intolerance or subtract outcome deaths.
Empagliflozin: 322/1,863 (17.3%); Placebo: 328/1,863 (17.6%). [5]
DELIVER: Premature stopping other than death
Trial disposition or safety population as specified; Median 2.3 years. Premature nondeath disposition stopping; separate from temporary interruption and safety AE count.
Dapagliflozin: 444/3,131 (14.2%); Placebo: 442/3,132 (14.1%). [8]
DELIVER: AE-related permanent stopping
Trial disposition or safety population as specified; Median 2.3 years; through 30 days after last dose. Permanent AE discontinuation in safety population; FDA Table 20.
Dapagliflozin: 182/3,126 (5.8%); Placebo: 181/3,127 (5.8%). [7]
EMPEROR-Preserved: Premature stopping other than death
Trial disposition or safety population as specified; Median 26.2 months. Premature nondeath treatment stopping in randomized groups.
Empagliflozin: 696/2,997 (23.2%); Placebo: 699/2,991 (23.4%). [3]
EMPEROR-Preserved: AE-related permanent stopping
Trial disposition or safety population as specified; Trial median 26.2 months. Broader safety AE stopping includes fatal events; not equivalent to the primary nondeath AE stopping passage.
Empagliflozin: 571/2,996 (19.1%); Placebo: 551/2,989 (18.4%). [10]
Korean single-center observational HF cohort: Persistent SGLT2 medication stopping
775 HF patients, mixed agents and EF; 70.6% diabetes; One-year Kaplan-Meier estimate; cohort median follow-up 567 days. Both adverse events and other reasons; temporary holds followed by resumption excluded. 85 total stops are not a one-year event count; no drug-specific comparator.
SGLT2 inhibitor: 7.5%. [11]
DELIVER: Serious UTI
Safety population; selective nonserious-event collection; Trial median 2.3 years; first dose through 30 days after last dose. FDA applicant-query Table 24; not the frequency of all mild infections.
Dapagliflozin: 41/3,126 (1.3%); Placebo: 37/3,127 (1.2%). [7]
DELIVER: UTI leading to permanent discontinuation
Safety population; selective nonserious-event collection; Trial median 2.3 years; first dose through 30 days after last dose. FDA applicant-query Table 24; not the frequency of all mild infections.
Dapagliflozin: 13/3,126 (0.4%); Placebo: 9/3,127 (0.3%). [7]
DELIVER: Genital infection leading to permanent discontinuation
Safety population; selective nonserious-event collection; Trial median 2.3 years; first dose through 30 days after last dose. FDA applicant-query Table 24; not the frequency of all mild infections.
Dapagliflozin: 3/3,126 (0.1%); Placebo: 0/3,127 (0%). [7]