What is the recommended dosing guideline for Jardiance (empagliflozin) in adults with type 2 diabetes?

Dosing Guidelines for Jardiance (Empagliflozin) in Type 2 Diabetes

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

Standard Dosing Protocol

• Starting dose: 10 mg once daily in the morning 3, 1, 2
• Dose adjustment: May increase to 25 mg once daily if needed for additional glycemic control 2
• Administration: Can be taken with or without food 1, 2
• Timing: Morning administration is recommended 2

Renal Function Considerations

Renal function assessment is required before initiating Jardiance and periodically thereafter:

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment required 3, 1, 2
• eGFR <45 mL/min/1.73 m²: Not recommended for initiation for glycemic control 3, 1, 2
• eGFR <30 mL/min/1.73 m²: Contraindicated 3, 1
• Dialysis patients: Contraindicated 3, 1

Indications Beyond Glycemic Control

For patients with established cardiovascular disease or heart failure, the 10 mg daily dose is sufficient for cardiovascular and renal risk reduction benefits, with no need for dose titration 3, 1:

• Reduces risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease 3, 2
• Reduces risk of hospitalization for heart failure 3

Special Considerations

• Volume status: Correct volume depletion prior to initiation 2
• Concomitant medications:
  • If patient is on insulin or sulfonylureas, consider reducing doses of these agents to minimize hypoglycemia risk 1
  • If patient is on diuretics, monitor for hypotension 3, 2
• Perioperative management: Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 3, 1

Monitoring

• Efficacy monitoring: HbA1c, fasting plasma glucose
• Safety monitoring:
  • Signs of hypotension, especially in elderly patients or those with renal impairment 2
  • Genital mycotic infections 3, 1
  • Ketoacidosis, regardless of blood glucose levels 1, 2
  • Renal function 2

Clinical Insights

While some research suggests that alternate-day dosing might be effective due to empagliflozin's 13.1-hour half-life 4, this approach is not supported by guidelines or FDA labeling. The standard daily dosing has demonstrated significant cardiovascular benefits in large clinical trials such as EMPA-REG OUTCOME, which showed a 38% relative risk reduction in cardiovascular death 5.

The 10 mg dose achieves near-maximal glucose-lowering efficacy according to exposure-response analyses 6, which explains why this dose is sufficient for cardiovascular and renal benefits. However, the 25 mg dose may provide additional glycemic control for some patients 7.