What is the recommended dosage and usage of Jardiance (Empagliflozin) for patients with type 2 diabetes?

Empagliflozin (Jardiance) Dosage and Usage for 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 if additional glycemic control is needed. 1

Standard Dosing Recommendations

• Initial dose: 10 mg once daily in the morning
• Dose adjustment: May increase to 25 mg once daily if additional glycemic control is needed
• Administration: Can be taken with or without food 1
• Timing: Morning administration is recommended 2, 1

Renal Function Considerations

Renal function assessment is required before initiating therapy:

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment required 2, 1
• eGFR <45 mL/min/1.73 m²: Not recommended for initiation for glycemic control 3, 2
• eGFR <30 mL/min/1.73 m²: Contraindicated 3, 2, 1
• Dialysis patients: Contraindicated 2, 1
• Monitoring: Periodic assessment of renal function is recommended after initiation 1

Special Considerations

Volume Status

• Correct volume depletion prior to initiation 1
• Use with caution in patients at risk for hypotension (elderly, low systolic blood pressure, concurrent diuretic use) 2, 1

Concomitant Medications

• Insulin or sulfonylureas: Consider reducing doses when adding empagliflozin to minimize hypoglycemia risk 2
• Diuretics: Consider reducing diuretic dose due to potential additive effect 3

Perioperative Management

• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 3, 2

Efficacy and Benefits

Empagliflozin provides multiple benefits for patients with type 2 diabetes:

• Glycemic control: Reduces HbA1c by approximately 0.8% 2
• Cardiovascular benefits:
  • Reduces risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease 3, 2
  • Reduces risk of hospitalization for heart failure 3, 2
• Weight effects: Modest weight reduction 4
• Blood pressure: Modest reduction in blood pressure 4

Monitoring and Adverse Effects

Key Monitoring Parameters

• Renal function before and periodically during treatment 1
• Signs and symptoms of hypotension 1
• Genital mycotic infections 2, 1
• Signs of diabetic ketoacidosis, regardless of blood glucose levels 1

Common Adverse Effects

• Genital fungal infections (more common in women) 2, 5
• Urinary tract infections 3
• Volume depletion symptoms 1

Contraindications

• History of serious hypersensitivity to empagliflozin 1
• Severe renal impairment (eGFR <30 mL/min/1.73 m²) 2, 1
• End-stage renal disease or dialysis 2, 1

Clinical Pearls

• The 10 mg dose is sufficient for cardiovascular and renal risk reduction benefits, with no need for dose titration for these outcomes 3, 2
• The glucose-lowering effect is blunted in patients with reduced kidney function 2, 6
• Empagliflozin carries a low inherent risk of hypoglycemia due to its insulin-independent mechanism of action 4
• Empagliflozin has not been associated with increased risk of amputation or bone fractures that have been reported with some other SGLT2 inhibitors 4

By following these dosing recommendations and monitoring guidelines, patients with type 2 diabetes can safely benefit from empagliflozin therapy while minimizing potential adverse effects.