What are the guidelines for initiating Jardiance (Empagliflozin) therapy?

From the Guidelines

Jardiance (empagliflozin) therapy should be initiated at 10 mg once daily, with careful consideration of the patient's renal function, as it is not recommended for those with an eGFR <30 mL/min/1.73m² for glycemic control or <20 mL/min/1.73m² for heart failure 1. When initiating Jardiance, it is essential to assess the patient's volume depletion risk factors and correct them if present before beginning therapy 1.

Key Considerations

• Patients should have adequate renal function with an eGFR ≥30 mL/min/1.73m² for glycemic control or ≥20 mL/min/1.73m² for heart failure 1.
• Jardiance can be added to existing diabetes medications, including metformin, sulfonylureas, pioglitazone, and insulin 1.
• Patients should be educated about potential side effects, such as genital mycotic infections, urinary tract infections, and the rare but serious risk of diabetic ketoacidosis 1.

Monitoring and Risk Mitigation

• Monitor patients for signs of ketoacidosis, such as nausea, vomiting, and abdominal pain, and temporarily discontinue the medication during periods of reduced oral intake or acute illness 1.
• Counsel patients on genital hygiene to reduce the risk of genital mycotic infections 1.
• Monitor for hypovolemia and consider proactive dose reduction of diuretics in patients at high risk 1.

Mechanism of Action

Jardiance works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which increases urinary glucose excretion and lowers blood glucose levels while also providing cardiovascular and renal benefits independent of its glucose-lowering effects 1.

Dose Adjustment

The dose of Jardiance may need to be adjusted based on the patient's renal function, with a maximum daily dose of 10 mg for patients with an eGFR <45 mL/min/1.73m² 1.

Special Populations

Jardiance has been shown to be effective in patients with heart failure, with an eGFR ≥20 mL/min/1.73m² 1. In patients with chronic kidney disease, Jardiance can be initiated for those with an eGFR ≥20 mL/min/1.73m², with careful monitoring of renal function and adjustment of the dose as needed 1.

From the FDA Drug Label

Assess renal function before initiating JARDIANCE. Do not initiate JARDIANCE if eGFR is below 45 mL/min/1.73 m2 The recommended dose of JARDIANCE is 10 mg once daily, taken in the morning, with or without food Hypotension: Before initiating JARDIANCE assess and correct volume status in patients with renal impairment, the elderly, in patients with low systolic blood pressure, and in patients on diuretics. Ketoacidosis: Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue JARDIANCE, evaluate and treat promptly. Before initiating JARDIANCE, consider risk factors for ketoacidosis

The guidelines for initiating Jardiance (Empagliflozin) therapy are:

• Assess renal function before starting the medication, and do not initiate if the eGFR is below 45 mL/min/1.73 m2.
• Start with a dose of 10 mg once daily, taken in the morning, with or without food.
• Assess and correct volume status in patients with renal impairment, the elderly, those with low systolic blood pressure, and those on diuretics to prevent hypotension.
• Consider risk factors for ketoacidosis before initiating JARDIANCE, and monitor for signs and symptoms of metabolic acidosis. 2

From the Research

Guidelines for Initiating Jardiance (Empagliflozin) Therapy

• Empagliflozin is indicated for the treatment of type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise to improve glycemic control 3, 4.
• The recommended dose of empagliflozin is 10 mg or 25 mg once daily, taken orally 3, 4.
• Empagliflozin can be used as monotherapy or in combination with other antidiabetic agents, such as metformin, sulfonylureas, or insulin 5, 6.
• When initiating empagliflozin therapy, patients should be monitored for adverse effects, such as genital infections, kidney failure, and diabetic ketoacidosis 5, 3.
• Empagliflozin has been shown to have a favorable effect on cardiovascular outcomes, particularly in patients with established cardiovascular disease (CVD) 5, 4.
• The efficacy of empagliflozin increases with the level of hyperglycemia, but decreases in patients with renal insufficiency 3.

Patient Selection

• Empagliflozin is suitable for patients with T2DM who have not achieved adequate glycemic control with diet and exercise alone or with other antidiabetic agents 3, 6.
• Patients with a history of cardiovascular disease may benefit from empagliflozin therapy due to its cardioprotective effects 5, 4.
• Empagliflozin may be considered as a second-line treatment option for patients who have not responded to metformin or other antidiabetic agents 6.

Dosing and Administration

• Empagliflozin can be administered once daily, with or without food 3, 4.
• The dose of empagliflozin can be adjusted based on patient response and tolerability 3, 4.
• A pilot trial suggested that administering empagliflozin every other day may be effective in improving glycemic control in Japanese patients with T2DM 7.