Recommended Dosing of Jardiance (Empagliflozin) for Type 2 Diabetes
The recommended starting dose of Jardiance (empagliflozin) for adults with type 2 diabetes is 10 mg once daily, taken in the morning, with or without food. 1, 2
Standard Dosing Regimen
- Initial dose: 10 mg once daily
- Maximum dose: May be increased to 25 mg once daily if additional glycemic control is needed 1, 2
- Administration: Take in the morning, with or without food 1
Renal Function Considerations
Empagliflozin dosing is significantly affected by kidney function:
- eGFR ≥45 mL/min/1.73 m²: No dose adjustment required 2, 3
- eGFR <45 mL/min/1.73 m²: Not recommended for initiation for glycemic control 2, 3
- eGFR <30 mL/min/1.73 m²: Contraindicated 2, 1
- Dialysis patients: Contraindicated 2
Cardiovascular and Renal Benefits
The 10 mg daily dose is sufficient for cardiovascular and renal risk reduction benefits in patients with:
- Established cardiovascular disease
- Heart failure with reduced or preserved ejection fraction 2
No dose titration is needed for these cardiovascular or renal protective effects 2.
Special Considerations
Monitoring Requirements
- Assess renal function before initiating Jardiance 1
- Monitor for signs of hypotension, especially in patients on diuretics 2, 1
- Watch for genital mycotic infections, which occur more frequently with SGLT2 inhibitors 1, 4
Medication Adjustments
- If patient is on insulin or sulfonylureas, consider reducing doses of these agents to minimize hypoglycemia risk 2
- Discontinue Jardiance at least 3 days before planned surgery to prevent postoperative ketoacidosis 2, 3
Clinical Efficacy
Empagliflozin typically reduces HbA1c by approximately 0.8% 4, with additional benefits including:
- Weight reduction (approximately 2 kg)
- Blood pressure reduction (systolic ~4 mmHg, diastolic ~2 mmHg) 4
- Cardiovascular protection demonstrated in the EMPA-REG OUTCOME trial 4, 5
- Renal protection with slower progression of kidney disease 5
Common Pitfalls to Avoid
- Initiating in patients with eGFR <45 mL/min/1.73 m² for glycemic control
- Failing to reduce insulin or sulfonylurea doses when adding empagliflozin
- Not discontinuing before surgery
- Overlooking the need to monitor for genital mycotic infections
- Continuing treatment if eGFR falls persistently below 45 mL/min/1.73 m² 1
Empagliflozin's unique mechanism of action provides glycemic control through an insulin-independent pathway, making it a valuable addition to the therapeutic options for type 2 diabetes management 6.