Farxiga Side Effects: Should You Pay Attention to Those TV Warnings?

Drug commercials are easy to tune out. After all the cheerful music, smiling actors and beautiful scenery, an announcer suddenly races through a frightening list of adverse reactions. Most viewers probably stop listening or are distracted by the beautiful scenery, kids, pets and action. But Farxiga side effects became very real for one of our readers.

She developed intense vaginal itching after starting Farxiga (dapagliflozin) for type 2 diabetes. What finally helped her connect the symptom to the drug was something many people ignore: the warning sandwiched into the middle of a television drug commercial.

First, a Word about Drug Names:

Drug companies work hard to create memorable drug names. People sing and dance about Jardiance (empagliflozin). You almost assuredly have seen a commercial that states:

“Jardiance is a little pill with a big story to tell…”

Some of the Farxiga commercials just repeat the name [FAR-SEE-GUH] over and over without telling you what the drug is for. They are referred to as “reminder ads.” Here is an example of a Farxiga reminder ad:

Jardiance and Farxiga (and others such as Invokana, Synjardy and Steglatro) are called SGLT2 inhibitors. They are prescribed for a number of serious conditions.

Jardiance has the FDA’s blessing for treating type 2 diabetes, cardiovascular disease, heart failure and chronic kidney disease.

Farxiga has a green light to treat: type 2 diabetes, heart failure and chronic kidney disease.

A Farxiga Side Effect Hiding in Plain Sight

The following question and answer recently ran in our nationally syndicated People’s Pharmacy newspaper column:

Q. A doctor prescribed Farxiga to treat my type 2 diabetes. Within a few weeks, I developed the worst vaginal itch I have ever experienced.

At first, I couldn’t figure out why. However, whenever I see a TV ad for a drug I am taking, my ears perk up. If I am on that drug, I listen intently and read the “mouse print” at the end about side effects. (It helps to have recorded a program so I can push “pause” and replay while I read.)

The light bulb went off immediately when I saw the ad for Farxiga. I ditched it and the itching stopped. I wrote a note to the doctor and said so.

Never ignore the lightning-speed voice-overs and teeny-tiny print about possible side effects. Doctor or not — NOBODY cares more about my health than I do.

A. Farxiga (dapagliflozin) commercials do mention side effects such as urinary tract or genital yeast infections.

Farxiga Commercial from a decade ago:

More recently, Farxiga commercials discuss other benefits:

Farxiga commercial for chronic kidney disease: 

The newer commercial mentions “a rare life-threatening bacterial infection in the skin of the perineum.” That is the area between the anus and the genitals. More about this shortly.

There are many other options for controlling blood sugar in type 2 diabetes. You can learn about drugs such as metformin, glipizide and GLP-1 agonists such as liraglutide (Victoza) and semaglutide (Ozempic) in our eGuide to Preventing & Treating Diabetes. This online guide is available under the Health eGuides tab.

What Could Have Caused the Vaginal Itching?

The reader’s intense vaginal itching could have been caused by a genital yeast infection or genital irritation. Farxiga belongs to a family of diabetes medicines that cause the kidneys to remove more glucose through the urine. That can be useful for lowering blood sugar. But extra sugar in the urine and genital area can also encourage the growth of yeast.

Genital yeast infections are a well-recognized Farxiga side effect.

The prescribing information for Farxiga warns that it increases the risk of genital fungal infections. In placebo-controlled diabetes trials, genital fungal infections occurred in 1.5% of women receiving placebo compared with 8.4% taking Farxiga 5 mg.

That makes vaginal yeast infection or genital irritation a plausible explanation for this reader’s severe itching.

Could It Have Been a Urinary Tract Infection?

Farxiga can also be associated with urinary tract infections.

A UTI, however, generally produces somewhat different symptoms. Burning during urination, urinary urgency, frequent urination and sometimes lower abdominal discomfort are more typical.

Intense vaginal or vulvar itching is much more characteristic of a genital yeast infection.

Symptoms alone cannot always make the diagnosis, however. Anyone who develops a new genital or urinary problem after starting Farxiga should let the prescriber know.

Patients also should not ordinarily stop an important diabetes, heart or kidney medicine on their own without discussing the situation with the health professional who prescribed it.

Farxiga Side Effects Can Rarely Become Much More Serious

This brings us to one of the most alarming warnings in Farxiga television commercials. You may have heard the announcer refer to:

“a rare life-threatening bacterial infection in the skin of the perineum.”

That rather clinical description refers to Fournier’s gangrene, also known as necrotizing fasciitis of the perineum. In plain English, this is a rapidly spreading flesh-eating infection involving tissue around the genitals and anus. It can be fatal!

On August 29, 2018, the FDA warned that this rare but very serious complication had been reported in people taking this class of diabetes medicines. These drugs include Farxiga, Jardiance, Invokana and Steglatro.

What Does “Perineum” Mean Anyway?

Television commercials sometimes warn about an infection “in the skin of the perineum.” But how many viewers actually know where the perineum is? It is the area between the genitals and the anus. This is a part of human anatomy that many people would rather not discuss. That may be precisely why doctors, pharmacists and drug commercials need to be especially clear about it.

A warning is not terribly useful if the patient has no idea where the dangerous symptoms might appear.

Another Reader Discovers This Frightening Warning

The following question and answer also ran in our nationally syndicated People’s Pharmacy newspaper column:

Q. My doctor urged me to take Jardiance for type 2 diabetes. When I did some research on this medication, I found that it could cause “necrotizing fasciitis of the perineum.” This is flesh-eating disease of the area from the vagina to the anus. The commercials I’ve seen lately mention this side effect in a less threatening way as an “irritation.” That’s so misleading!

Our response:

A. When we watched a Jardiance commercial, we found this:

“Serious side effects include increased ketones in blood or urine and infection between and around the anus and genitals, both may be fatal, severe allergic reactions, dehydration, urinary tract or genital yeast infections in men and women and low blood sugar…”

“Tell your doctor about lightheadedness, weakness, fever, pain, tenderness, redness, or swelling between the anus and genitals. You may have increased risk for lower limb loss.”

That certainly deserves attention, even though Fournier’s gangrene is very rare.

What Exactly Is Fournier’s Gangrene?

Fournier’s gangrene is a form of necrotizing fasciitis.

Here is how the FDA described it:

“Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. The bacteria usually get into the body through a cut or break in the skin, where they quickly spread and destroy the tissue they infect.”

The disease was named after French physician Alfred Fournier, who described the condition in the 19th century.

StatPearls describes Fournier’s gangrene as a rapidly progressive infection involving superficial and deep tissues of the genital, perineal and anal regions. One reason this condition can be especially dangerous is that the infection may already be spreading beneath the surface before dramatic skin changes appear.

How Many Cases of Fournier’s Gangrene Have Been Reported?

When the FDA first issued its warning in 2018, the agency had identified only 12 cases associated with these diabetes drugs. Subsequent surveillance identified substantially more.

FDA researchers reported in the Annals of Internal Medicine that they found 55 unique cases of Fournier’s gangrene among people taking these drugs between March 2013 and January 2019.

The patients ranged in age from 33 to 87. All required surgical removal of infected tissue.

Among the reported complications:

• Nine patients developed sepsis or septic shock.
• Four developed acute kidney injury.
• Some required additional major surgical procedures.
• Three patients died.

That does not mean the complication is common. It remains extraordinarily rare. But “rare” does not necessarily mean “unimportant” when an adverse reaction can become life-threatening very quickly.

Complete List of Diabetes Drugs Linked to Flesh-Eating Disease

In its 2018 warning, the FDA listed the following medications as containing an SGLT2 inhibitor:

Farxiga Side Effects and Genital Infections

Farxiga works in an unusual way. Instead of simply lowering the amount of glucose circulating in the bloodstream, it causes the kidneys to excrete more glucose in the urine. In plain English, patients essentially pee out some of their excess sugar. That can lower blood glucose and may also provide important heart and kidney benefits.

But there is a potential downside.

More glucose around the urinary and genital areas can create an environment favorable to microorganisms, particularly yeast. A 2024 review in Cureus discusses this biological mechanism as one possible explanation for the association between these drugs and genital infections.

Ordinary genital yeast infections are vastly more common than Fournier’s gangrene. Most are treatable and do not progress to this devastating disease. Nevertheless, patients need to understand which symptoms are merely uncomfortable and which could signal an emergency.

Farxiga Side Effects: Which Symptoms Are an Emergency?

Anyone taking Farxiga or a similar medicine should be aware of symptoms involving the genitals or the area extending toward the anus.

The FDA advises people to seek medical attention promptly for:

• Tenderness or pain around the genitals or perineum
• Redness or swelling in that area
• Fever above 100.4° F
• Feeling generally unwell, particularly along with genital or perineal symptoms

Fournier’s gangrene can progress very quickly. This is not a situation where someone should simply wait several days to see whether the problem gets better. If physicians suspect Fournier’s gangrene, treatment can require immediate broad-spectrum antibiotics and urgent surgery to remove infected tissue.

Other Names for This Flesh-Eating Disease

You may encounter this condition under several names in the medical literature:

• Necrotizing fasciitis
• Fournier’s gangrene
• Flesh-eating bacteria (or flesh-eating disease)
• Idiopathic gangrene of the scrotum
• Streptococcal scrotal gangrene
• Synergistic necrotising cellulitis
• Phagedena

Which Diabetes Drugs Carry This Warning?

The medicines include:

• Farxiga (dapagliflozin)
• Jardiance (empagliflozin)
• Invokana (canagliflozin)
• Steglatro (ertugliflozin)
• Brenzavvy (bexagliflozin)

Several combination diabetes medicines also contain one of these ingredients. Patients should remember that these drugs can provide substantial benefits. Depending on the individual drug and the patient’s condition, doctors may prescribe them not just to lower blood sugar but also to help protect the heart and kidneys.

The message is not to panic about Farxiga. It is to know what to watch for.

Do People Really Listen to TV Drug Warnings?

Our reader’s experience raises a larger question. How much attention do people really pay to those rapid-fire warnings at the end of prescription drug commercials? The advertisement starts with appealing images. People are hiking, gardening, dancing, traveling or playing with grandchildren.

Then comes the scary part.

An announcer races through infections, kidney problems, allergic reactions, low blood sugar and other potentially serious complications while the happy actors continue smiling in the background. It is tempting to tune all of that out.

Our reader did something different. She stopped. She listened. She even paused the television so she could read what she called the “mouse print.” Then she realized that the miserable symptom she had developed after starting Farxiga might actually be related to the medication. That is precisely what a drug warning is supposed to accomplish.

Should Patients Have to Learn About Farxiga Side Effects From TV?

NO! Patients should not have to depend on television advertisements to discover important information about their medicines. Ideally, the prescriber should explain the most important potential adverse reactions before the patient starts treatment. The pharmacist should reinforce the warning when the prescription is dispensed.

But medical visits can be rushed. Medication guides may go unread. Pharmacy printouts can be pages long and in hard-to-read print. That means the seemingly irritating warning at the end of a TV commercial can occasionally serve an important purpose.

Our reader’s experience is a perfect example. When she heard a warning that matched what she was experiencing, the “light bulb went off.”

The Bottom Line on Farxiga Side Effects

Farxiga can be a valuable medicine for people with diabetes, heart disease or kidney disease. Like every powerful medicine, though, it can also cause adverse reactions.

Farxiga side effects include genital yeast infections that can produce itching, burning, redness or irritation.

Much more rarely, Farxiga and similar diabetes medicines have been linked to Fournier’s gangrene, a potentially fatal infection involving tissue around the genitals and anus. The two conditions should not be confused.

Vaginal itching by itself is far more suggestive of a yeast infection or irritation than Fournier’s gangrene. Pain, tenderness, redness or swelling in the genital or perineal area, especially if accompanied by fever or feeling seriously ill, deserves immediate medical attention.

What Should You Do If You Take These Diabetes Drugs?

We do not want patients to panic, or to stop taking their medication without speaking to their doctor. SGLT2 inhibitors offer real benefits, and for many patients, those benefits outweigh the risks. But you deserve to make that decision with full information.

Here is what we recommend:

• Ask your doctor or pharmacist directly: “What are the signs of a serious skin infection I should watch for?”
• Know the location: the perineum is the area between your genitals and your anus.
• Do not dismiss early symptoms. Redness, swelling, or pain in that area, especially with fever, is a medical emergency.
• If you develop those symptoms, go to an emergency room immediately. Do not wait for a routine appointment.
• Report adverse reactions to the FDA at 1-800-FDA-1088 or at www.fda.gov/safety/medwatch.

Our reader has offered one additional lesson worth remembering:

The next time an announcer starts racing through the side effects at the end of a television drug commercial, don’t automatically tune out. You may hear something you really need to know.

There are many options for managing type 2 diabetes. We discuss them in our eGuide to Preventing and Treating Diabetes, available under the Health eGuides tab.

Have you ever developed a strange symptom and later discovered that it was a side effect of one of your medicines? Did your doctor or pharmacist warn you about it beforehand? Please share your experience in the comment section below. If you know someone with diabetes you might want to pass this article along. Thank you for supporting our work.