Invokana (canagliflozin) and Jardiance (empagliflozin) are both SGLT2 inhibitors for type 2 diabetes that work by making the kidneys excrete more glucose in urine, and the two drugs have largely overlapping benefits with some differences in specific trial-proven indications. This guide compares their mechanisms, approved uses, and trial evidence.
This is general information, not medical advice.
Invokana vs Jardiance at a glance
| Invokana (canagliflozin) | Jardiance (empagliflozin) | |
|---|---|---|
| Drug class | SGLT2 inhibitor | SGLT2 inhibitor |
| FDA-approved for | Type 2 diabetes, reducing risk of kidney disease progression (CREDENCE trial) | Type 2 diabetes, heart failure (with or without diabetes), cardiovascular risk reduction |
| Heart failure indication | Not a primary approved use | Yes, specifically approved regardless of diabetes status |
| Common side effect | Genital yeast infections | Genital yeast infections |
| Initial approval | 2013 | 2014 |
How SGLT2 inhibitors work
Both drugs block SGLT2 (sodium-glucose cotransporter 2) in the kidneys, the protein responsible for reabsorbing glucose back into the bloodstream during normal kidney filtration. Blocking it causes excess glucose to be excreted in urine instead, lowering blood glucose levels through a mechanism entirely independent of insulin, unlike many other diabetes drug classes. This insulin-independent action is part of why SGLT2 inhibitors carry a relatively low risk of causing dangerously low blood sugar when used alone.
Where their approved uses diverge
Both are approved as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes, the shared core indication. Beyond that baseline, their specific trial-proven additional benefits differ somewhat:
Invokana’s CREDENCE trial specifically evaluated canagliflozin’s effect on reducing the risk of end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death, supporting a kidney-protection-focused indication that has become a notable part of its current positioning.
Jardiance has a broader cardiovascular and heart failure profile in its current labeling: it’s approved to reduce cardiovascular risk in adults with type 2 diabetes and established cardiovascular disease (based on the EMPA-REG OUTCOME trial), and separately approved for heart failure regardless of whether the patient has diabetes, a significant additional use that has expanded empagliflozin’s role well beyond diabetes treatment alone.
Comparative trial data
Head-to-head comparisons compiled across their respective outcome trials show broadly similar glucose-lowering effects at comparable doses (roughly 0.7 to 1.0 percentage point HbA1c reductions across various dose levels in monotherapy studies for both drugs), with the meaningful differentiation coming from their distinct outcome trials (CREDENCE for kidney outcomes with canagliflozin, EMPA-REG OUTCOME and later heart failure trials for empagliflozin) rather than from substantially different core diabetes efficacy.
Side effects
Both share the class-wide SGLT2 inhibitor side effect profile: increased risk of genital yeast infections and urinary tract infections (related to the increased glucose in urine, which can promote fungal and bacterial growth), and a risk of diabetic ketoacidosis in susceptible patients, along with dehydration-related effects like low blood pressure, especially in patients also taking diuretics.
Who each might suit
Factors that may point toward Invokana:
- Chronic kidney disease alongside type 2 diabetes, given its specific kidney-outcomes trial data
- Established good response to canagliflozin specifically
Factors that may point toward Jardiance:
- Heart failure, with or without diabetes, given its dedicated heart failure approval
- Established cardiovascular disease alongside type 2 diabetes
- A broader current label reflecting more recently expanded cardiovascular indications
Frequently asked questions
Do both drugs work the same way?
Yes, both are SGLT2 inhibitors that block glucose reabsorption in the kidneys, causing excess glucose to be excreted in urine, an insulin-independent mechanism.
Can Jardiance treat heart failure without diabetes?
Yes, Jardiance is specifically approved for heart failure regardless of whether the patient has type 2 diabetes, a use Invokana does not carry in the same way.
Is Invokana good for kidney disease?
Its CREDENCE trial specifically evaluated and supported a role in reducing risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease.
Why do SGLT2 inhibitors cause yeast infections?
Because they work by increasing glucose excretion in urine, and that extra sugar can promote fungal and bacterial growth in the genital area, a class-wide side effect for both drugs.
Which was approved first?
Invokana, approved in 2013; Jardiance followed in 2014.