What is the recommended use and dosage of Jardiance (empagliflozin) in patients with type 2 diabetes?

Recommended Use and Dosage of Jardiance (Empagliflozin) in Type 2 Diabetes

The recommended dosage of Jardiance (empagliflozin) for patients 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 in patients who tolerate the medication well. 1

Indications and Benefits

Jardiance is indicated for:

• Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes
• Reducing the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease 1

Key benefits include:

• Significant reduction in cardiovascular mortality (38%) and all-cause mortality (32%) 2
• Reduction in composite of cardiovascular death or hospitalization for heart failure (21%) in patients with HFrEF 2
• Modest weight loss (2-3 kg) and blood pressure reduction 2
• Low risk of hypoglycemia when used as monotherapy 2, 3

Dosing Algorithm

1. Initial Assessment:

   • Assess renal function prior to initiation (eGFR)
   • Evaluate volume status

2. Starting Dose:

   • Start with 10 mg once daily in the morning 1
   • Can be taken with or without food

3. Dose Titration:

   • May increase to 25 mg once daily if well tolerated 1
   • Monitor for efficacy and tolerability

4. Special Considerations:

   • Correct volume depletion prior to initiation if present 1
   • Consider reducing doses of sulfonylureas or insulin when starting Jardiance to prevent hypoglycemia 2
   • Consider reducing diuretic doses if applicable, as Jardiance may contribute to intravascular volume contraction 2

Renal Function Considerations

• Before starting: Assess renal function 1
• Do not initiate if eGFR is less than 45 mL/min/1.73 m² 1
• No dose adjustment needed if eGFR ≥ 45 mL/min/1.73 m² 1
• Discontinue if eGFR falls persistently below 45 mL/min/1.73 m² 1
• Contraindicated in severe renal impairment, end-stage renal disease, or dialysis 1

Monitoring Requirements

• Renal function: Periodically after initiation 1
• Signs and symptoms of hypotension, especially in:
  • Elderly patients
  • Patients with renal impairment
  • Patients with low systolic blood pressure
  • Patients on diuretics 1
• Treatment response: Check HbA1c after 3 months 2
• Signs of ketoacidosis (regardless of blood glucose levels) 1

Precautions and Contraindications

Contraindications:

• History of serious hypersensitivity to empagliflozin 1
• Severe renal impairment (eGFR < 45 mL/min/1.73 m²), end-stage renal disease, or dialysis 1
• Type 1 diabetes 1

Warnings:

• Hypotension due to intravascular volume contraction 1
• Ketoacidosis (may occur even with blood glucose < 250 mg/dL) 1
• Genital mycotic infections 2
• Increased risk of urinary tract infections 3

Perioperative Management

• Discontinue Jardiance at least 3 days before planned surgery to prevent postoperative ketoacidosis 2
• Resume when patient is clinically stable and oral intake has normalized

Combination Therapy

Jardiance can be effectively combined with:

• Metformin: Provides complementary mechanisms and additive effects on weight loss 2
• GLP-1 receptor agonists: Complementary mechanisms with low hypoglycemia risk 2
• DPP-4 inhibitors: Offers additive glycemic control through complementary mechanisms 2

When combining with sulfonylureas or insulin, consider dose reduction of these agents to minimize hypoglycemia risk 2.

Jardiance has demonstrated significant cardiovascular and renal benefits beyond glycemic control, making it particularly valuable for patients with established cardiovascular disease or at high risk for heart failure 2, 4, 5.