Starting Dose for Jardiance (Empagliflozin) in Congestive Heart Failure
The recommended starting dose for Jardiance (empagliflozin) in patients with congestive heart failure is 10 mg once daily, taken in the morning with or without food. 1
Dosing Guidelines
- Initial dose: 10 mg once daily in the morning
- Dose adjustment: May be increased to 25 mg once daily in patients who tolerate the initial dose
- Administration: Can be taken with or without food
- Timing: Should be taken in the morning
Clinical Evidence Supporting This Dosing
The FDA-approved drug label for Jardiance specifically recommends starting with 10 mg once daily 1. This dosing was used in the landmark EMPEROR-Reduced trial, which demonstrated that empagliflozin 10 mg daily significantly reduced the composite outcome of cardiovascular death or hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) 2.
Renal Considerations
- Assess renal function before initiating Jardiance
- Do not initiate if eGFR is below 45 mL/min/1.73 m²
- Discontinue if eGFR falls persistently below 45 mL/min/1.73 m² 1
Volume Status Considerations
It's important to correct volume depletion prior to initiating Jardiance 1. This is particularly relevant in heart failure patients who may be on diuretic therapy.
Dose Optimization
While the starting dose is 10 mg daily, some evidence suggests that 25 mg may provide greater improvement in cardiac function parameters:
- A small study comparing 25 mg versus 10 mg in HFrEF patients found greater improvements in left ventricular ejection fraction and left ventricular end-diastolic diameter with the 25 mg dose, with comparable safety profiles 3
- However, the major clinical trials establishing mortality and hospitalization benefits used the 10 mg dose 2
Monitoring After Initiation
- Monitor renal function periodically
- Watch for signs of volume depletion, particularly in patients also receiving diuretics
- Be alert for potential side effects including genital tract infections, which were more common with empagliflozin treatment 2
Common Pitfalls to Avoid
- Initiating in patients with inadequate renal function (eGFR <45 mL/min/1.73 m²)
- Failing to correct volume depletion before starting therapy
- Not monitoring renal function after initiation
- Overlooking potential drug interactions with other heart failure medications
Empagliflozin has shown significant benefits in heart failure patients regardless of diabetes status, with reductions in cardiovascular death, heart failure hospitalizations, and improvements in renal outcomes 2, 4. Starting with the appropriate dose of 10 mg daily ensures patients receive these benefits while minimizing potential adverse effects.