Empagliflozin and dapagliflozin are the two market-leading SGLT2 inhibitors. They are in the same class and work by the same mechanism, with similar A1C reduction (0.7 to 1.0 percent), similar weight loss (2 to 3 kg), and similar blood pressure effects. The differences are mostly in trial evidence — empagliflozin has the strongest cardiovascular mortality data, dapagliflozin has the largest CKD trial. For most patients, the practical choice comes down to insurance coverage, cost, and clinician familiarity rather than meaningful efficacy differences.
Quick Comparison
| Feature | Empagliflozin (Jardiance) | Dapagliflozin (Farxiga) |
|---|---|---|
| Manufacturer | Boehringer Ingelheim / Eli Lilly | AstraZeneca |
| FDA approval year | 2014 | 2014 |
| Available doses | 10 mg, 25 mg | 5 mg, 10 mg |
| A1C reduction | 0.7 to 1.0 percent | 0.7 to 1.0 percent |
| Weight loss | 2 to 3 kg | 2 to 3 kg |
| BP reduction | 3 to 5 / 2 mmHg | 3 to 5 / 2 mmHg |
| T2D approval | Yes | Yes |
| CV death reduction (key trial) | EMPA-REG: 38 percent | DECLARE: neutral on CV death |
| HF hospitalization reduction | EMPA-REG: 35 percent | DECLARE: 27 percent |
| HFrEF approval | Yes (EMPEROR-Reduced) | Yes (DAPA-HF) |
| HFpEF approval | Yes (EMPEROR-Preserved) | Yes (DELIVER) |
| CKD approval | Yes (EMPA-KIDNEY) | Yes (DAPA-CKD) |
| eGFR cutoff for initiation | ≥ 20 | ≥ 25 |
| US retail price / month | $540 to $580 | $500 to $570 |
Same Class, Same Core Mechanism
Both drugs block the SGLT2 transporter in the proximal tubule of the kidney. Normally this transporter reabsorbs about 90 percent of glucose filtered by the kidney. With an SGLT2 inhibitor, that reabsorption is blocked, and 50 to 80 grams of glucose are excreted in urine each day. The mechanism is identical for empagliflozin and dapagliflozin.
- Both inhibit SGLT2 with high selectivity over SGLT1
- Both produce similar daily glucosuria
- Both cause mild osmotic diuresis
- Both have glucose-dependent effects (minimal hypoglycemia alone)
- Empagliflozin has slightly higher SGLT2/SGLT1 selectivity ratio
- Half-lives differ slightly but both support once-daily dosing
Trial Evidence Head-to-Head
| Outcome | Empagliflozin Trial / Result | Dapagliflozin Trial / Result |
|---|---|---|
| T2D + CV disease (MACE) | EMPA-REG: 14 percent reduction | DECLARE: neutral |
| T2D + CV disease (CV death) | EMPA-REG: 38 percent reduction | DECLARE: neutral |
| HFrEF | EMPEROR-Reduced: 25 percent reduction | DAPA-HF: 26 percent reduction |
| HFpEF | EMPEROR-Preserved: 21 percent reduction | DELIVER: 18 percent reduction |
| CKD | EMPA-KIDNEY: 28 percent reduction | DAPA-CKD: 39 percent reduction |
| HF hospitalization in T2D | EMPA-REG: 35 percent reduction | DECLARE: 27 percent reduction |
Where Empagliflozin May Have the Edge
- T2D with established cardiovascular disease — EMPA-REG showed a clear mortality benefit that DECLARE did not replicate for dapagliflozin
- Lower eGFR initiation — empagliflozin can be started down to eGFR 20, dapagliflozin to 25
- Slightly higher glycemic effect at the 25 mg dose
- Pediatric T2D approval (down to age 10) — empagliflozin has this; dapagliflozin does not yet
Where Dapagliflozin May Have the Edge
- 5 mg starting dose offers flexibility for elderly or fragile patients
- DAPA-CKD trial included a broader range of CKD patients including non-diabetic CKD with albuminuria
- Slightly larger absolute CKD effect size in head-to-head trial summaries (though indirect comparison)
- First approved for HF (DAPA-HF predated EMPEROR-Reduced by about 1 year)
Side Effects Side by Side
- Genital yeast infections — 8 to 12 percent, both drugs
- Urinary tract infections — 5 to 9 percent, both drugs
- Volume depletion — 1 to 3 percent, both drugs
- Increased urination — 3 to 4 percent, both
- Euglycemic DKA — less than 0.1 percent in T2D, both
- Fournier gangrene — extremely rare boxed warning, both
- Bone fracture — neutral with both (in contrast to canagliflozin)
- Amputation — neutral with both (in contrast to canagliflozin’s CANVAS signal)
- Bladder cancer — early theoretical concern with dapagliflozin not confirmed in long-term data
Dosing
| Indication | Empagliflozin Dose | Dapagliflozin Dose |
|---|---|---|
| T2D start | 10 mg daily | 5 mg or 10 mg daily |
| T2D maintenance | 10 to 25 mg daily | 5 to 10 mg daily |
| HFrEF / HFpEF | 10 mg daily | 10 mg daily |
| CKD | 10 mg daily | 10 mg daily |
| With food? | Optional | Optional |
Contraindications and Cautions
- Type 1 diabetes — both contraindicated
- Dialysis — both not used
- Severe hepatic impairment — dapagliflozin used with caution (more hepatic metabolism); empagliflozin generally acceptable
- Recurrent genital or urinary infections — both relative contraindications
- Pregnancy — both not recommended
- Active foot ulcer at risk of progression — increased monitoring
How Doctors Pick
- Insurance formulary status — often the strongest practical driver
- Established CV disease — slight lean toward empagliflozin for mortality data
- CKD with significant albuminuria — either reasonable; some lean dapagliflozin based on DAPA-CKD
- eGFR 20 to 25 — empagliflozin preferred for initiation
- Need for 5 mg starting dose — dapagliflozin only
- Patient preference based on copay card
- Clinician familiarity and prescribing pattern
What Is the Same
- Mechanism of action
- A1C effect at standard doses
- Weight loss
- Blood pressure reduction
- Side effect profile
- Once-daily dosing
- Heart failure benefit across the EF spectrum
- CKD benefit with proteinuria
- No interaction with metformin, DPP-4 inhibitors, or GLP-1 agonists
- Need to hold for surgery, illness, or fasting
Related Reading
See our treatment hub, Is Farxiga the same as Jardiance, and Is prediabetes reversible. For supporting trial data, see DAPA-CKD.
The Bottom Line
Empagliflozin and dapagliflozin are the two leading SGLT2 inhibitors. They share mechanism, A1C effect, weight effect, blood pressure effect, and side effect profile. The main differences are in trial evidence — empagliflozin has stronger cardiovascular mortality data (EMPA-REG OUTCOME), and dapagliflozin has the largest CKD trial (DAPA-CKD). Both are approved for type 2 diabetes, heart failure with reduced or preserved ejection fraction, and chronic kidney disease. Cost is similar in the US. In practice, the choice often comes down to insurance formulary, copay card availability, and clinician preference rather than meaningful efficacy differences. Talk to your doctor about which fits your specific cardiovascular and kidney risk profile.
