Discontinuing Empagliflozin Before Pregnancy
Empagliflozin should be discontinued at least 6 weeks before attempting conception to minimize potential risks to the fetus. 1
Rationale for Discontinuation
Empagliflozin (Jardiance) is not recommended during the second and third trimesters of pregnancy based on animal data showing adverse renal effects. The FDA drug label indicates:
- Animal studies showed renal pelvic and tubule dilatations when empagliflozin was administered during periods corresponding to late second and third trimesters of human pregnancy 2
- These renal changes occurred at doses approximately 13 times the maximum clinical dose
- While empagliflozin was not found to be teratogenic in animal studies, there is limited human pregnancy data 2
Timing of Discontinuation
The American Association for the Study of Liver Diseases provides clear guidance that empagliflozin should be discontinued at least 6 weeks before conception 1. This timeframe allows for:
- Complete elimination of the drug from the body
- Reduction of potential risks to early fetal development
- Transition to alternative diabetes management if needed
Preconception Planning
When discontinuing empagliflozin before pregnancy:
Consult with healthcare providers: Work with both an endocrinologist and obstetrician to develop a comprehensive preconception plan
Alternative diabetes management: Discuss alternative medications that are safer during pregnancy
Glycemic control: Establish optimal glycemic control before conception, as poorly controlled diabetes increases risks of:
- Diabetic ketoacidosis
- Pre-eclampsia
- Spontaneous abortions
- Preterm delivery
- Stillbirth 2
Contraception During Transition
Effective contraception should be used while taking empagliflozin and during the 6-week washout period after discontinuation to prevent unintended pregnancy exposure.
Special Considerations
Monitoring after discontinuation: Regular blood glucose monitoring is essential after stopping empagliflozin to maintain glycemic control
Potential for diabetes worsening: Be prepared for possible deterioration in glycemic control after discontinuation
Cardiovascular risk: While empagliflozin has cardiovascular benefits 3, these must be weighed against potential fetal risks when planning pregnancy
After Pregnancy
Empagliflozin can be considered for resumption after pregnancy is complete and breastfeeding has ended, as there is no information regarding its presence in human milk or effects on breastfed infants 2.