What is the recommended dosage of Jardiance (Empagliflozin) for adults with type 2 diabetes?

Recommended Dosage of Jardiance (Empagliflozin) for Adults with Type 2 Diabetes

The recommended starting dose of Jardiance for adults with type 2 diabetes is 10 mg once daily, which can be increased to 25 mg once daily if needed for additional glycemic control. 1

Dosing Guidelines Based on Renal Function

Renal function significantly impacts Jardiance dosing recommendations:

• eGFR ≥45 mL/min/1.73 m²:

  • Start with 10 mg once daily
  • May increase to 25 mg once daily if additional glycemic control is needed 2, 1

• eGFR 30-44 mL/min/1.73 m²:

  • Maximum 10 mg daily for kidney and cardiovascular benefits
  • Note: Glucose-lowering efficacy is reduced at this level of kidney function 2

• eGFR <30 mL/min/1.73 m²:

  • Not recommended for glycemic control
  • Initiation not recommended with eGFR <25 mL/min/1.73 m² 2

Special Considerations

Timing of Administration

• Take once daily in the morning 1
• Can be taken with or without food

Dose Adjustments

• No dose adjustments needed based on age, gender, or race
• No dose adjustments required for mild to moderate hepatic impairment

Monitoring Recommendations

• Monitor renal function before initiating Jardiance and periodically thereafter
• More frequent monitoring is recommended for patients with eGFR <60 mL/min/1.73 m² 2
• Monitor for signs of volume depletion, especially when initiating therapy

Clinical Benefits Beyond Glycemic Control

Jardiance offers several benefits beyond glucose control that may influence dosing decisions:

• Cardiovascular Protection: Both 10 mg and 25 mg doses have demonstrated cardiovascular benefits 3
• Renal Protection: Slows progression of kidney disease in patients with type 2 diabetes 4
• Weight Reduction: Average weight loss of approximately 2 kg 1, 5
• Blood Pressure Reduction: Systolic reduction of approximately 4 mmHg 5

Common Pitfalls to Avoid

1. Failing to assess renal function before initiating therapy - Always check eGFR before starting Jardiance
2. Not considering drug interactions - Be cautious when combining with insulin or sulfonylureas due to hypoglycemia risk
3. Overlooking volume status - Consider decreasing diuretic doses before starting Jardiance in patients at risk for hypovolemia 2
4. Discontinuing at first sign of eGFR decline - A reversible decrease in eGFR is expected and generally not a reason to stop therapy 2

Practical Dosing Algorithm

1. Initial Assessment:

   • Check eGFR
   • Evaluate cardiovascular and renal status
   • Review current medications

2. Dosing Decision:

   • eGFR ≥45 mL/min/1.73 m²: Start with 10 mg once daily
   • eGFR 30-44 mL/min/1.73 m²: 10 mg once daily (maximum)
   • eGFR <30 mL/min/1.73 m²: Not recommended for glycemic control

3. Follow-up Monitoring:

   • Reassess glycemic control after 3 months
   • If additional glycemic control needed and eGFR ≥45 mL/min/1.73 m², consider increasing to 25 mg once daily
   • Monitor renal function regularly

By following these evidence-based dosing recommendations, you can optimize the benefits of Jardiance while minimizing potential risks for patients with type 2 diabetes.