What are the recommended dosages of Empagliflozin (Jardiance) and Metformin, and how often should kidney function be checked in patients taking these medications?

From the Guidelines

Jardiance (empagliflozin) and metformin are recommended for patients with type 2 diabetes, with a typical starting dose of 10 mg once daily for Jardiance and 500 mg once or twice daily with meals for metformin, and kidney function should be assessed before starting treatment and monitored at least annually or every 3-6 months for those with reduced kidney function or risk factors for kidney disease. The dosage of metformin may need to be adjusted based on kidney function, with a recommended dose reduction for patients with an eGFR of 45-59 mL/min/1.73m² and halving the dose for those with an eGFR of 30-44 mL/min/1.73m² 1. Jardiance is not recommended for patients with severely impaired kidney function (eGFR below 30 mL/min/1.73m²) 1. Some key points to consider when prescribing these medications include:

• Monitoring kidney function regularly, especially in patients with reduced kidney function or risk factors for kidney disease
• Adjusting the dose of metformin based on kidney function to prevent lactic acidosis
• Considering alternative treatments for patients with severely impaired kidney function
• Educating patients on the importance of regular kidney function monitoring and the potential risks associated with these medications. According to the KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease, metformin is recommended for patients with type 2 diabetes and an eGFR of 30 mL/min/1.73m² or higher, with a suggested approach to dosing based on the level of kidney function 1. Additionally, the diabetic kidney disease management field guide for health care professionals recommends monitoring kidney function and adjusting the dose of SGLT2 inhibitors, such as Jardiance, based on kidney function 1. Overall, the use of Jardiance and metformin in patients with type 2 diabetes requires careful consideration of kidney function and regular monitoring to minimize the risk of adverse effects.

From the FDA Drug Label

2.2 Patients with Renal Impairment Assessment of renal function is recommended prior to initiation of JARDIANCE and periodically thereafter. JARDIANCE should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m2. No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1. 73 m2. JARDIANCE should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m2

The recommended dosage of JARDIANCE is 10 mg once daily in the morning, taken with or without food, and may be increased to 25 mg once daily.

• JARDIANCE and metformin are used for the treatment of type 2 diabetes mellitus.
• The recommended dosage of metformin is not specified in the provided drug labels.
• Kidney values should be checked prior to initiation of JARDIANCE and periodically thereafter 2.
• JARDIANCE should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m2 2.

From the Research

Jardiance (Empagliflozin) and Metformin Usage

• Jardiance (Empagliflozin) is a sodium glucose cotransporter-2 (SGLT2) inhibitor used for the treatment of adults with type 2 diabetes 3.
• Metformin is a first-line agent for the management of type 2 diabetes in patients with chronic kidney disease (CKD) 4.

Recommended Dosage

• The recommended dosage of Empagliflozin is 10 mg or 25 mg once daily [(5,6,7)].
• The dosage of Metformin is not specified in the provided studies, but it is generally recommended to be taken orally, 2-3 times a day, with meals [no specific reference].

Kidney Value Checks

• Patients with type 2 diabetes and established cardiovascular disease who are treated with Empagliflozin should have their kidney function monitored regularly [(5,6,7)].
• The frequency of kidney value checks is not specified in the provided studies, but it is generally recommended to monitor kidney function at least annually in patients with CKD [no specific reference].
• Empagliflozin has been shown to reduce the risk of kidney disease progression and slow the decline in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes [(5,6,7)].

Combination Therapy

• Empagliflozin can be used as monotherapy or as a component of combination therapy with other antidiabetic agents, including Metformin 3.
• The combination of Empagliflozin and Metformin may be beneficial for patients with type 2 diabetes and CKD, as it can provide improved glycemic control and reduce the risk of cardiovascular and renal events 4.