When should lisinopril, empagliflozin (Jardiance), and insulin glargine (Lantus) 10 units be discontinued?

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Last updated: September 17, 2026 • View editorial policy

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When to Stop Lisinopril, Jardiance, and Lantus 10 Units

These medications should be temporarily stopped during acute illness ("sick days") when the patient has symptoms like vomiting, diarrhea, fever, or reduced oral intake, and resumed within 24-48 hours after symptoms resolve and normal eating/drinking resumes. 1

Sick Day Management Protocol

When to Stop These Medications

Based on consensus guidelines for sick day medication guidance 1:

Jardiance (empagliflozin - SGLT2 inhibitor):

  • Stop immediately when acute illness begins (96% consensus) 1
  • Particularly critical due to risk of ketoacidosis, volume depletion, and acute kidney injury 2
  • Stop if patient has: vomiting, diarrhea, fever >38°C, reduced oral intake, or dehydration 1

Lisinopril (ACE inhibitor):

  • Stop temporarily during acute illness (90% consensus) 1
  • Risk of hypotension and acute kidney injury when volume depleted 3
  • Especially important if patient is also on diuretics or has reduced fluid intake

Lantus (insulin glargine):

  • Do NOT routinely stop - instead adjust dose based on blood glucose 1
  • If blood glucose is LOW: hold insulin until glucose recovers (96% consensus) 1
  • If blood glucose is ELEVATED: increase basal insulin by 10-20% empirically 1
  • Monitor blood glucose every 4-6 hours while symptomatic 1

Duration of Medication Hold

Stop for up to 3 days (100% consensus) or until symptoms resolve 1:

  • Resume Jardiance and lisinopril at usual doses within 24-48 hours of eating and drinking normally (95% consensus) 1
  • Resume insulin at usual doses as soon as symptoms improve and normal eating resumes (100% consensus) 1

When to Seek Medical Help

Contact healthcare provider if 1:

  • Symptoms persist beyond 72 hours (100% consensus)
  • Cannot maintain fluid intake (100% consensus)
  • Recurrent low blood glucose readings (96% consensus)
  • Blood glucose remains significantly elevated despite adjustments after 24 hours (96% consensus)

Critical Warning Signs - Call 911

Seek emergency care for 1:

  • Difficulty or rapid breathing (100% consensus)
  • Reduced consciousness or new confusion (96% consensus)
  • Fainting or falls (71% consensus)

Additional Considerations

For Jardiance specifically:

  • Check ketones if on SGLT2 inhibitor during illness (95% consensus) 1
  • FDA warns of ketoacidosis risk, even with normal blood glucose 2
  • Discontinue permanently if necrotizing fasciitis (Fournier's gangrene) suspected 2

For Lisinopril:

  • Dose adjustment needed if creatinine clearance <30 mL/min 3
  • May need permanent discontinuation if prolonged hypotension (systolic BP <90 mmHg for >1 hour) 3

For Lantus:

  • Once opened, vials should be discarded after 28 days regardless of remaining insulin 4
  • This is a sterility and stability issue, not a "sick day" consideration

Common Pitfall to Avoid

Do not confuse temporary sick day holds with permanent discontinuation. Most patients should restart these medications promptly once acute illness resolves, as they provide important cardiovascular and renal protection. The goal is to prevent acute complications (ketoacidosis, acute kidney injury, hypotension) while maintaining long-term disease management.

References

4
Research

Prevalence of insulin glargine vial use beyond 28 days in a Medicaid population.

Journal of the American Pharmacists Association : JAPhA, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.