Can Jardiance (empagliflozin) cause elevations in pancreatic enzymes?

Jardiance (Empagliflozin) and Pancreatic Enzyme Elevations

Jardiance (empagliflozin) can cause elevations in pancreatic enzymes and has been associated with cases of acute pancreatitis, though this is considered a rare adverse effect.

Evidence for Empagliflozin-Associated Pancreatic Enzyme Elevations

Several case reports have documented the association between empagliflozin and pancreatic involvement:

• Multiple case reports from 2020-2024 describe patients developing acute pancreatitis within weeks of initiating empagliflozin therapy 1, 2, 3, 4
• The timing relationship between drug initiation and symptom onset strongly suggests a causal relationship
• In these cases, other common causes of pancreatitis (gallstones, alcohol, hypertriglyceridemia) were excluded

Clinical Presentation and Diagnosis

When evaluating for possible empagliflozin-induced pancreatic enzyme elevations:

• Monitor for symptoms of pancreatitis including severe epigastric pain, nausea, and vomiting
• Diagnostic criteria for acute pancreatitis include:
  • Serum lipase elevation ≥3 times the upper limit of normal (more specific than amylase) 5
  • Compatible clinical features
  • Confirmatory imaging findings when necessary

Risk Assessment and Monitoring

While routine monitoring of pancreatic enzymes in asymptomatic patients on Jardiance is not recommended 6, clinicians should:

• Maintain high clinical suspicion in patients presenting with abdominal pain while on empagliflozin
• Consider drug-induced pancreatitis in the differential diagnosis after excluding common etiologies
• Be aware that enzyme elevations may occur even in the absence of clinical pancreatitis 7

Management of Suspected Cases

If empagliflozin-associated pancreatic involvement is suspected:

1. Discontinue empagliflozin immediately
2. Provide supportive care as indicated for pancreatitis
3. Consider alternative diabetes medications that don't have pancreatic effects
4. Document the adverse event for future reference

Important Considerations

• Pancreatic enzyme elevations and pancreatitis are not listed among the common side effects in the FDA labeling for SGLT2 inhibitors 6
• This adverse effect appears to be rare but potentially serious
• The mechanism by which empagliflozin may cause pancreatic inflammation remains unclear
• The risk may be higher in patients with other risk factors for pancreatitis

Differential Diagnosis

When evaluating elevated pancreatic enzymes in patients on Jardiance, consider other causes:

• Gallstone disease
• Alcohol consumption
• Hypertriglyceridemia (>1000 mg/dL)
• Other medications known to cause pancreatitis
• Critical illness (can cause non-specific enzyme elevations) 7

Careful clinical correlation is essential, as enzyme elevations alone are insufficient for diagnosis of pancreatitis, particularly in critically ill patients where non-specific elevations are common.