What is the recommended dose of empagliflozin (Jardiance) for the treatment of heart failure?

Recommended Dose of Empagliflozin (Jardiance) for Heart Failure Treatment

The recommended dose of empagliflozin (Jardiance) for the treatment of heart failure is 10 mg once daily, taken orally in the morning with or without food. 1

Dosing Considerations Based on Heart Failure Type

For Heart Failure with Reduced Ejection Fraction (HFrEF):

• Start with 10 mg once daily of empagliflozin 1, 2
• No dose titration is required for heart failure indication, unlike the diabetes indication where dose may be increased to 25 mg 1
• Efficacy for reducing cardiovascular death and hospitalization for heart failure was demonstrated with the 10 mg dose in the EMPEROR-Reduced trial 2

For Heart Failure with Preserved Ejection Fraction (HFpEF):

• Use 10 mg once daily of empagliflozin 3, 4
• The EMPEROR-Preserved trial demonstrated significant benefits with the 10 mg dose in patients with LVEF >40% 3

Renal Function Considerations

• Assess renal function prior to initiation and periodically thereafter 1
• For heart failure treatment:
  • eGFR ≥45 mL/min/1.73 m²: No dose adjustment needed 1
  • eGFR <45 mL/min/1.73 m²: Empagliflozin should not be initiated 1
  • If eGFR falls persistently below 45 mL/min/1.73 m², discontinue empagliflozin 1

Clinical Evidence Supporting the Dose

• The 10 mg daily dose was used in all major heart failure clinical trials:
  • EMPEROR-Reduced: 10 mg daily reduced the primary composite outcome of cardiovascular death or hospitalization for heart failure by 25% (HR 0.75; 95% CI, 0.65-0.86; P<0.001) 2
  • EMPEROR-Preserved: 10 mg daily reduced the same composite outcome by 21% (HR 0.79; 95% CI, 0.69-0.90; P<0.001) 3
  • Benefits were observed regardless of diabetes status 4

Timing of Initiation

• For hospitalized heart failure patients, empagliflozin can be initiated during hospitalization after the patient is stabilized 5
• The EMPULSE trial demonstrated safety and efficacy of in-hospital initiation of empagliflozin 10 mg daily 5

Important Considerations and Precautions

• Correct volume depletion prior to initiation 1
• Monitor for signs of hypotension, particularly in patients with renal impairment, elderly patients, those with low systolic blood pressure, or those on diuretics 1
• Be aware of the risk of ketoacidosis, especially in situations of reduced insulin, prolonged fasting, or carbohydrate restriction 1
• Genital mycotic infections and urinary tract infections are common adverse effects 6

Comparison with Other SGLT2 Inhibitors

• Both empagliflozin 10 mg and dapagliflozin 10 mg have demonstrated efficacy in heart failure treatment 7
• For patients with eGFR 20-30 mL/min/1.73m², dapagliflozin may be an alternative option, as it can be used at lower eGFR thresholds than empagliflozin 7

The 10 mg once daily dose of empagliflozin has consistently demonstrated significant benefits in reducing heart failure hospitalizations and cardiovascular death across the spectrum of heart failure, making it the appropriate dose for heart failure treatment regardless of ejection fraction or diabetes status.