From the Guidelines
The recommended starting dose of Jardiance (empagliflozin) for patients with Heart Failure with Reduced Ejection Fraction (HFrEF) is 10 mg once daily. This dose is typically taken orally in the morning with or without food and does not require titration. No dose adjustment is needed based on ejection fraction severity. However, patients should have adequate renal function with an estimated glomerular filtration rate (eGFR) of at least 20 mL/min/1.73m² before starting therapy. Empagliflozin works as a sodium-glucose cotransporter-2 (SGLT2) inhibitor, which reduces glucose reabsorption in the kidneys and promotes glucose excretion in urine. In heart failure patients, it provides benefits beyond glucose control, including reduced cardiac workload, improved cardiac metabolism, and decreased cardiac fibrosis. These mechanisms help reduce hospitalizations and mortality in HFrEF patients, regardless of whether they have diabetes. Patients should be monitored for potential side effects such as genital mycotic infections, urinary tract infections, and volume depletion, especially during the initial treatment period, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Some key points to consider when initiating empagliflozin in HFrEF patients include:
- Ensuring adequate renal function before starting therapy
- Monitoring for potential side effects, especially during the initial treatment period
- Understanding the benefits of empagliflozin in reducing hospitalizations and mortality in HFrEF patients, as supported by the 2024 ESC guidelines for the management of chronic coronary syndromes 1
- Recognizing the importance of a multidisciplinary approach to managing heart failure, including the use of SGLT2 inhibitors like empagliflozin, as recommended by the 2024 ESC guidelines 1.
It is essential to prioritize the patient's overall health and well-being when initiating empagliflozin, considering factors such as renal function, potential side effects, and the benefits of therapy in reducing morbidity and mortality.
From the FDA Drug Label
The recommended dose of JARDIANCE is 10 mg once daily in the morning, taken with or without food. The FDA drug label does not answer the question.
From the Research
Recommended Starting Dose of Jardiance for HFrEF Patients
- The recommended starting dose of Jardiance (Empagliflozin) for patients with Heart Failure with Reduced Ejection Fraction (HFrEF) is not explicitly stated in the provided studies 2, 3, 4.
- However, a study comparing different doses of Empagliflozin in HFrEF patients found that 25 mg/day and 10 mg/day of Empagliflozin were used, with 25 mg/day showing greater improvements in cardiac function 5.
- Another study discussing the management of HFrEF mentions that Sodium-glucose co-transporter 2 inhibitors, including Empagliflozin, have revolutionized the management of HFrEF patients, but does not specify a starting dose 4.
- A study on ACE inhibitors, angiotensin-2 receptor blockers, and beta-blockers in heart failure with reduced ejection fraction suggests that higher doses of medications may be more effective, but also increase the risk of adverse effects, and recommends starting at low doses and titrating up if tolerated 6.
- Based on the available information, it appears that the starting dose of Jardiance for HFrEF patients may be 10 mg/day, as used in the study by 5, but this is not explicitly confirmed by the other studies.
Key Considerations
- The choice of starting dose may depend on individual patient factors, such as renal function and tolerance to the medication.
- The studies provided do not include a direct comparison of 5 mg/day of Empagliflozin to other doses in HFrEF patients.
- Further research may be needed to determine the optimal starting dose of Jardiance for HFrEF patients.