What are the indications and recommended dosages for Empagliflozin (Jardiance) and Metformin?

From the Guidelines

Jardiance (empagliflozin) and metformin are recommended for the treatment of type 2 diabetes, with a typical starting dose of 10 mg once daily for Jardiance and 500 mg twice daily or 850 mg once daily for metformin, gradually increasing to a maximum of 2,000-2,550 mg daily. The dosage of Jardiance may need to be adjusted based on kidney function, with a maximum dose of 10 mg daily for patients with an estimated glomerular filtration rate (eGFR) of 30-44 mL/min/1.73 m², and initiation not recommended for patients with an eGFR of less than 30 mL/min/1.73 m² 1. For metformin, the dose should be reduced to 1000 mg/day for patients with an eGFR of 30-44 mL/min/1.73 m², and is contraindicated for patients with an eGFR of less than 30 mL/min/1.73 m² 1. Some key points to consider when prescribing these medications include:

• Jardiance is an SGLT2 inhibitor that helps the kidneys remove excess sugar through urine, while metformin reduces glucose production in the liver and improves insulin sensitivity.
• Jardiance offers additional benefits of weight loss and reduced cardiovascular risk, while metformin is typically the first-line treatment for type 2 diabetes.
• Both medications should be taken as prescribed, and patients should maintain regular blood glucose monitoring and follow-up with healthcare providers to assess effectiveness and adjust dosages if needed.
• The glucose-lowering efficacy of SGLT2 inhibitors, such as Jardiance, is reduced as eGFR declines, but kidney and cardiovascular benefits are preserved 1.
• Metformin is cleared by renal filtration, and very high circulating levels have been associated with lactic acidosis, although this complication is rare 2. It is essential to carefully evaluate the patient's kidney function and adjust the dosage accordingly to minimize the risk of adverse effects and maximize the benefits of these medications, as recommended by recent guidelines 3, 1.

From the FDA Drug Label

JARDIANCE is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated: as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus, to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease. The recommended dose of JARDIANCE is 10 mg once daily, taken in the morning, with or without food (2.1) Dose may be increased to 25 mg once daily (2. 1)

Jardiance and Metformin Uses and Recommended Dosage:

• Jardiance is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
• The recommended dosage of Jardiance is 10 mg once daily, which may be increased to 25 mg once daily.
• Metformin dosage is not specified in the provided drug labels, as they only pertain to Jardiance (Empagliflozin). 4 5

From the Research

Jiardiance and Metformin Usage

• Jiardiance (empagliflozin) and metformin are used in combination for the treatment of type 2 diabetes mellitus (T2DM) [ 6 , 7 ]
• The combination of empagliflozin and metformin has been shown to be effective and well tolerated in patients with T2DM [ 6 ]
• Empagliflozin is associated with cardiovascular (CV) and renal benefits, and is recommended as a treatment option for T2DM [ 6 , 8 ]

Recommended Dosage

• The recommended dosage of empagliflozin is 10mg or 25mg once daily, in combination with metformin [ 7 ]
• The combination of empagliflozin and metformin is available as a single-pill combination, which can provide a simplified treatment regimen [ 6 ]
• The dosage of metformin can vary, but it is typically started at a low dose and gradually increased to achieve optimal glycemic control [ 9 ]

Special Considerations

• Caution is required when using empagliflozin in fragile elderly patients and in patients with severe impaired renal function [ 7 ]
• The addition of empagliflozin to metformin therapy may be beneficial for patients with established CV disease or heart failure [ 7 , 8 ]