From the Guidelines
Jardiance (empagliflozin) should be held at least 3 days before surgery. This recommendation is based on the most recent and highest quality study, which suggests that SGLT-2 inhibitors, including empagliflozin, should be stopped ≥3 days prior to scheduled surgery due to the risk of diabetic and euglycemic ketoacidosis in the perioperative period 1. The main concern is the potential for volume depletion, electrolyte imbalances, and ketoacidosis when patients are fasting and under physiologic stress.
The mechanism of action of Jardiance as an SGLT2 inhibitor increases urinary glucose excretion, which can lead to hypovolemia and acute kidney injury, particularly in the perioperative period 1. Additionally, the risk of euglycemic diabetic ketoacidosis (DKA) is a serious complication that can occur in the surgical setting. Stopping Jardiance at least 3 days before surgery allows adequate time for the drug to be cleared from the system and reduces the risk of these complications.
It is essential for patients to discuss this timing with their healthcare provider, as individual circumstances may warrant adjustments to this recommendation. The medication can typically be restarted once the patient is eating normally and kidney function has been assessed as stable after surgery, usually 2-3 days post-procedure. Other guidelines also support holding SGLT2 inhibitors 3-4 days before surgery to minimize the risk of perioperative complications 1.
Key considerations for holding Jardiance before surgery include:
- Risk of diabetic and euglycemic ketoacidosis
- Potential for volume depletion and electrolyte imbalances
- Need for adequate time for the drug to be cleared from the system
- Importance of individualized recommendations based on patient circumstances
- Monitoring of kidney function and blood glucose levels after surgery before restarting the medication.
From the Research
Holding Jardiance Before Surgery
- The provided studies do not directly address how soon before surgery Jardiance (empagliflozin) needs to be held.
- However, it is known that SGLT2 inhibitors like empagliflozin can increase the risk of dehydration and ketoacidosis, especially in patients with chronic kidney disease or those undergoing surgery 2.
- In general, it is recommended to hold SGLT2 inhibitors 24-48 hours before surgery to minimize the risk of these complications, but the exact timing may vary depending on individual patient factors and the type of surgery being performed.
- Patients with chronic kidney disease or those at high risk of kidney injury may need to have their Jardiance held for a longer period before surgery, and their kidney function should be closely monitored perioperatively 3, 4.
- The decision to hold Jardiance before surgery should be made in consultation with the patient's healthcare provider, taking into account their individual medical history and the specific requirements of the surgery.
Key Considerations
- Dehydration and ketoacidosis are potential risks associated with SGLT2 inhibitors like Jardiance, especially in patients with chronic kidney disease or those undergoing surgery 2, 5.
- Close monitoring of kidney function and electrolyte levels is essential in patients taking Jardiance, especially in the perioperative period 3, 4.
- The long-term effects of empagliflozin in patients with chronic kidney disease have been shown to be beneficial in reducing the risk of kidney disease progression and cardiovascular events 5, 6.