Dapagliflozin vs Empagliflozin
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Dapagliflozin (Farxiga) and empagliflozin (Jardiance) are both sodium-glucose cotransporter 2 (SGLT2) inhibitors that have transformed the treatment of type 2 diabetes, heart failure, and chronic kidney disease [1][2]. These medications work by blocking glucose reabsorption in the kidneys, causing excess glucose to be excreted in the urine.
What makes SGLT2 inhibitors remarkable is their benefits beyond glucose control. Both dapagliflozin and empagliflozin have demonstrated significant reductions in cardiovascular events, heart failure hospitalizations, and kidney disease progression in landmark clinical trials [3][4][5].
While these two medications are often considered interchangeable by clinicians, they have distinct FDA-approved indications based on their respective clinical trial portfolios, and subtle differences in dosing and evidence base may influence prescribing decisions [1][2].
Dapagliflozin vs Empagliflozin: Side-by-side comparison
| Category | Dapagliflozin | Empagliflozin |
|---|---|---|
| Drug Class | SGLT2 inhibitor | SGLT2 inhibitor |
| Generic Name | Dapagliflozin | Empagliflozin |
| Brand Name | Farxiga | Jardiance |
| FDA Approved For | T2D, heart failure (HFrEF/HFpEF), CKD | T2D, heart failure (HFrEF/HFpEF), CKD, CV risk reduction |
| How It Works | Blocks SGLT2 in kidney proximal tubule | Blocks SGLT2 in kidney proximal tubule |
| Dosage Forms | Tablets (5, 10 mg) | Tablets (10, 25 mg) |
| Typical Dose | 10 mg once daily | 10-25 mg once daily |
| HbA1c Reduction | ~0.5-0.8% | ~0.5-0.8% |
| Landmark CV Trial | DECLARE-TIMI 58 | EMPA-REG OUTCOME |
| Common Side Effects | Genital infections, UTI, polyuria | Genital infections, UTI, polyuria |
| Cost (Brand) | ~$550-$600/month | ~$550-$600/month |
| Generic Available | Not yet (U.S.) | Not yet (U.S.) |
Efficacy: How well does each drug work?
Both medications provide comparable HbA1c reductions of approximately 0.5-0.8% and modest weight loss of 2-3 kg [1][2].
For cardiovascular outcomes, empagliflozin was first to demonstrate CV benefit. The EMPA-REG OUTCOME trial showed a 38% reduction in cardiovascular death in patients with type 2 diabetes and established cardiovascular disease [3]. Dapagliflozin's DECLARE-TIMI 58 trial showed a 17% reduction in the composite of CV death or heart failure hospitalization, primarily driven by heart failure reduction [4].
For heart failure, both have strong evidence regardless of diabetes status. DAPA-HF (dapagliflozin) and EMPEROR-Reduced (empagliflozin) showed significant reductions in heart failure hospitalizations and CV death in patients with heart failure with reduced ejection fraction (HFrEF) [5]. DELIVER and EMPEROR-Preserved extended benefits to heart failure with preserved ejection fraction (HFpEF).
For chronic kidney disease, DAPA-CKD demonstrated dapagliflozin's benefit in patients with CKD regardless of diabetes status, while EMPA-KIDNEY showed similar benefits for empagliflozin [1][2]. Both are FDA-approved for CKD risk reduction.
Side effects comparison
The side effect profiles are nearly identical, reflecting their shared SGLT2 mechanism [1][2]. Both increase the risk of genital mycotic infections (yeast infections) in 5-10% of patients (more common in women), urinary tract infections (7-9%), volume depletion/hypotension, and diabetic ketoacidosis (rare but serious, even with normal glucose levels) [1][2].
Both carry warnings about necrotizing fasciitis of the perineum (Fournier gangrene), an extremely rare but life-threatening complication [1][2]. Acute kidney injury can occur, particularly in volume-depleted patients.
Neither medication causes hypoglycemia when used alone, though risk increases when combined with insulin or sulfonylureas [1][2]. Both promote modest weight loss and mild blood pressure reduction, which are generally considered beneficial effects.
Cost comparison
Both medications are branded and expensive without insurance. Empagliflozin (Jardiance) costs approximately $550-$600 per month at list price [6]. Dapagliflozin (Farxiga) costs approximately $550-$600 per month [6]. With insurance or manufacturer savings cards, copays typically range from $0-$50 per month.
Generic versions are not yet available for either medication in the U.S. (as of 2025). Insurance formulary placement may favor one over the other depending on the plan.
Convenience and dosing
Both are once-daily oral medications, making convenience comparable [1][2]. Empagliflozin is available as 10 mg and 25 mg tablets [2]. Dapagliflozin is available as 5 mg and 10 mg tablets [1]. Neither requires dosing with food. Both are available in fixed-dose combinations with metformin (Synjardy, Xigduo XR) for convenience in diabetes management.
Which is right for you?
The choice between these two SGLT2 inhibitors often comes down to insurance formulary coverage, as clinical evidence supports both [1][2].
Dapagliflozin may be specifically preferred based on the DAPA-CKD trial evidence for CKD regardless of diabetes [1]. Empagliflozin may be preferred based on the EMPA-REG OUTCOME trial's strong cardiovascular death reduction signal [3].
In practice, most guidelines recommend SGLT2 inhibitors as a class for patients with type 2 diabetes and cardiovascular disease, heart failure, or CKD [5]. Either agent is an excellent choice.
This information is for educational purposes only. Consult your healthcare provider for personalized diabetes and cardiovascular treatment.
Frequently asked questions
References
- [Regulatory] Dapagliflozin (Farxiga) prescribing information. AstraZeneca. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/202293s028lbl.pdf Accessed 2025-06-15.
- [Regulatory] Empagliflozin (Jardiance) prescribing information. Boehringer Ingelheim/Lilly. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/204629s033lbl.pdf Accessed 2025-06-15.
- [Regulatory] Zinman B, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME). N Engl J Med. 2015;373(22):2117-2128. https://doi.org/10.1056/NEJMoa1515920 Accessed 2025-06-15.
- [Regulatory] Wiviott SD, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes (DECLARE-TIMI 58). N Engl J Med. 2019;380(4):347-357. https://doi.org/10.1056/NEJMoa1812389 Accessed 2025-06-15.
- [Regulatory] McMurray JJV, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction (DAPA-HF). N Engl J Med. 2019;381(21):1995-2008. https://doi.org/10.1056/NEJMoa1911303 Accessed 2025-06-15.
- [Observational] GoodRx price comparison: dapagliflozin and empagliflozin. https://www.goodrx.com Accessed 2025-06-15.
Written and fact-checked by PrescriptionDrugs.org Editorial Team
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