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

Jardiance (Empagliflozin) Dosing Guidelines for Type 2 Diabetes

The recommended dose of Jardiance (empagliflozin) for adults with type 2 diabetes is 10 mg once daily in the morning, taken with or without food, with possible titration to 25 mg daily if needed for additional glycemic control. 1

Initial Dosing and Titration

• Starting dose: 10 mg once daily in the morning
• May increase to 25 mg once daily in patients who tolerate the initial dose and need additional glycemic control
• Can be taken with or without food

Renal Function Considerations

Jardiance has specific dosing restrictions based on kidney function:

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment required
• eGFR <45 mL/min/1.73 m²: Not recommended for initiation 1, 2
• Severe renal impairment, end-stage renal disease, or dialysis: Contraindicated 1

Assessment of renal function is recommended:

• Before initiating Jardiance
• Periodically during treatment
• Discontinue if eGFR persistently falls below 45 mL/min/1.73 m² 1

Special Populations and Considerations

Volume Status

• Correct volume depletion prior to initiation 1
• Use caution in patients at risk for hypotension:
  • Elderly patients
  • Patients with low systolic blood pressure
  • Patients on diuretics 1

Surgical Procedures

• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 2

Medication Adjustments

• If patient has well-controlled HbA1c at baseline or history of hypoglycemic events:
  • Consider weaning or stopping sulfonylureas or glinides
  • Consider reducing total daily insulin dose by approximately 20% when starting therapy 2

Monitoring

• Monitor for signs and symptoms of hypotension after initiating therapy
• Assess for ketoacidosis regardless of blood glucose levels if patient presents with signs of severe metabolic acidosis 1
• Watch for common adverse effects:
  • Genital fungal infections (more common in women)
  • Urinary tract infections
  • Euglycemic diabetic ketoacidosis 2

Clinical Benefits Beyond Glycemic Control

Jardiance has demonstrated significant benefits beyond glucose control:

• Cardiovascular death risk reduction in adults with type 2 diabetes and established cardiovascular disease 1, 3
• Slower progression of kidney disease in high-risk patients 4
• Reduction in hospitalization for heart failure 2, 3

Contraindications

• History of serious hypersensitivity reaction to empagliflozin
• Severe renal impairment (eGFR <30 mL/min/1.73 m²)
• End-stage renal disease or dialysis 1

Common Pitfalls to Avoid

1. Initiating in patients with inadequate renal function: Always check eGFR before starting
2. Failing to correct volume depletion: Address dehydration before starting therapy
3. Not monitoring for ketoacidosis: Be vigilant for this rare but serious complication
4. Overlooking medication interactions: Adjust insulin or sulfonylurea doses to prevent hypoglycemia
5. Continuing medication before surgery: Remember to stop at least 3 days before planned procedures

Jardiance offers a convenient once-daily dosing regimen with demonstrated benefits for cardiovascular and renal outcomes in addition to its glucose-lowering effects, making it a valuable option for adults with type 2 diabetes.