Can You Stop Jardiance Abruptly?
No, you should not stop Jardiance (empagliflozin) abruptly in most circumstances—the medication should be continued for its cardiovascular and kidney benefits even when glucose-lowering effects diminish, and only temporarily discontinued in specific high-risk situations such as 3-4 days before scheduled surgery, during critical illness, or when diabetic ketoacidosis is suspected.
When Jardiance Should Be Continued
The most important principle is that SGLT2 inhibitors like empagliflozin provide cardiovascular and kidney protection independent of their glucose-lowering effects 1, 2. This means:
- Continue empagliflozin even as kidney function declines: Once initiated, continue until dialysis or transplantation, even when eGFR falls below 45 mL/min/1.73 m² where glucose-lowering efficacy is minimal 1, 2
- Continue during minor creatinine increases: An initial "dip" in eGFR of 3-5 mL/min/1.73 m² is expected and does not represent true tubular injury—this is hemodynamic and reversible 3, 4
- Continue in heart failure patients: The medication reduces cardiovascular death and heart failure hospitalization regardless of diabetes status 5, 6
When Jardiance MUST Be Temporarily Stopped
Before Surgery (Mandatory)
Discontinue empagliflozin 3 days before any scheduled surgery 7, 4, 6. This is to reduce the risk of perioperative metabolic acidosis and diabetic ketoacidosis. The 2024 AHA/ACC perioperative guidelines give this a Class 1 recommendation 7.
During Acute Illness (Sick Day Management)
Stop empagliflozin immediately if 1, 4, 6:
- Diabetic ketoacidosis is suspected (even with normal glucose—"euglycemic DKA")
- Critical illness with sepsis, bleeding, or severe dehydration
- Prolonged fasting or inability to maintain oral intake
- Severe volume depletion with hypotension
Warning Signs Requiring Immediate Discontinuation
Instruct patients to stop and seek medical attention if they develop 6:
- Nausea, vomiting, abdominal pain with labored breathing (ketoacidosis symptoms)
- Severe genital or perineal pain with fever >100.4°F (Fournier's gangrene)
- Signs of severe volume depletion
Special Considerations for a 75-Year-Old Man
Age alone is not a contraindication—empagliflozin has demonstrated consistent cardiovascular and mortality benefits across all age groups, including patients ≥75 years 8, 9. In fact, the cardiovascular death reduction was similar in older patients (HR 0.55 in ≥75 years) 8.
However, monitor more closely for:
- Frailty and low BMI: These are the primary risk factors for adverse events in older adults, not chronological age 10
- Volume depletion: Older adults may be more susceptible, especially if on concurrent diuretics 11
- Genital infections: More common in older adults but usually manageable 1
Clinical Pitfalls to Avoid
Don't stop for minor creatinine increases during decongestion: In heart failure patients, worsening kidney function during successful diuresis is associated with better outcomes than failure to decongest 3
Don't stop when glucose control is adequate: The cardiovascular and kidney benefits persist independent of glucose lowering 1, 2
Don't restart immediately after surgery: Wait until the patient is eating normally and risk of ketoacidosis has passed 4
Don't confuse hemodynamic GFR changes with true kidney injury: The initial eGFR dip is expected and protective long-term 4
Practical Restart Protocol After Temporary Discontinuation
When restarting after surgery or acute illness:
- Ensure patient is eating and drinking normally
- Confirm no ongoing infection or volume depletion
- Resume at the same dose (no titration needed)
- Monitor for volume status in first few days
Bottom line: Jardiance provides life-saving cardiovascular and kidney benefits that should not be interrupted except for the specific high-risk situations outlined above 1, 2, 5, 7.