Does Jardiance (empagliflozin) cause an increase in urination?

Jardiance (Empagliflozin) and Increased Urination

Yes, Jardiance (empagliflozin) definitely causes an increase in urination as a direct result of its mechanism of action. This is not a side effect but rather the primary way the medication works to lower blood glucose levels.

Mechanism Behind Increased Urination

Empagliflozin works by inhibiting sodium-glucose cotransporter 2 (SGLT2) proteins in the renal proximal tubules, which:

• Reduces reabsorption of filtered glucose from the kidneys 1
• Promotes urinary glucose excretion 1
• Creates an osmotic diuresis effect (pulling water with the glucose) 2

Extent of Increased Urination

• Clinical studies show that urinary glucose excretion increases immediately after starting Jardiance 1
• Patients excrete approximately 64-78 grams of glucose per day in urine 1
• Mean 24-hour urine volume increases by about 341 mL on Day 1 of treatment with 25 mg empagliflozin 1
• This effect continues with ongoing treatment, though it may slightly decrease to about 135 mL above baseline by Day 5 1

Clinical Presentation of Increased Urination

The FDA label for Jardiance specifically notes the following urination-related effects 1:

• Increased urination (polyuria)
• More frequent urination (pollakiuria)
• Nighttime urination (nocturia)

In clinical trials, these effects were reported significantly more frequently with Jardiance than with placebo:

• 3.4% of patients on 10 mg Jardiance
• 3.2% of patients on 25 mg Jardiance
• 1.0% of patients on placebo

Specifically for nocturia (nighttime urination):

• 0.8% of patients on 25 mg Jardiance
• 0.3% of patients on 10 mg Jardiance
• 0.4% of patients on placebo

Clinical Implications

1. Volume depletion risk: The osmotic diuresis can lead to intravascular volume contraction, though this occurs in only 0.3-0.5% of patients 1

2. Blood pressure reduction: The diuretic effect contributes to lowering blood pressure by approximately 4-5 mmHg systolic and 2-3 mmHg diastolic 2

3. Monitoring needs:

   • Patients should be monitored for signs of dehydration, especially when starting therapy
   • Higher risk in elderly patients or those taking diuretics 1

Patient Education Points

Patients should be informed that:

• Increased urination is expected and indicates the medication is working
• Adequate hydration is important while taking this medication
• The effect is most pronounced when starting therapy but may become less noticeable over time
• Nighttime bathroom trips may increase

Cautions

• Use with caution in patients at risk for volume depletion 1
• Medication adjustments may be necessary if blood pressure decreases significantly 2
• The diuretic effect may be beneficial in heart failure patients but requires monitoring 3

This increased urination effect is consistent across the SGLT2 inhibitor class and represents the fundamental mechanism by which these medications work to eliminate excess glucose from the body.