Dose Conversion from Empagliflozin (Jardiance) 10mg to Ertugliflozin (Steglatro)
When switching from Jardiance (empagliflozin) 10mg to Steglatro (ertugliflozin), the appropriate dose is 5mg of ertugliflozin once daily.
Rationale for Dose Selection
The dose recommendation is based on several key considerations:
According to the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) consensus report, empagliflozin is typically prescribed at 10mg daily, while ertugliflozin is available in 5mg and 15mg doses 1.
The standard starting dose for ertugliflozin is 5mg once daily, which provides comparable glycemic efficacy to other SGLT2 inhibitors at their standard doses 1.
Clinical pharmacology data shows that ertugliflozin 5mg provides clinically meaningful efficacy with a similar safety profile to empagliflozin 10mg 2.
Clinical Considerations
Efficacy Comparison
Network meta-analysis research has shown that ertugliflozin 5mg provides similar or better glycemic control compared to other SGLT2 inhibitors, including being more effective than dapagliflozin 5mg in lowering HbA1c when added to metformin 3.
The VERTIS CV trial demonstrated that ertugliflozin effectively reduces HbA1c, fasting plasma glucose, and body weight when added to existing diabetes therapy 4, 5.
Renal Function Considerations
Important renal dosing differences exist between these medications:
If your patient has renal impairment with eGFR <45 mL/min/1.73m², neither medication should be initiated, and alternative agents should be considered 1.
Cardiovascular Benefits
- Both medications have demonstrated cardiovascular benefits, though with some differences:
Practical Administration Guidelines
Ertugliflozin 5mg can be administered once daily without regard to meals 2.
No dose adjustment is needed when switching from empagliflozin 10mg to ertugliflozin 5mg for patients with mild to moderate renal impairment (eGFR ≥45 mL/min/1.73m²) 1, 2.
Monitor for typical SGLT2 inhibitor side effects including genital mycotic infections, urinary tract infections, and volume depletion 1.
Special Considerations
If the patient has inadequate glycemic control on ertugliflozin 5mg after an appropriate trial period (typically 3 months), consider increasing to ertugliflozin 15mg daily 4.
For patients with established cardiovascular disease, both medications provide cardiovascular benefits, though the specific outcomes may differ slightly between the two agents 1, 6.
If the patient is taking the medication primarily for heart failure benefits rather than glycemic control, careful consideration of the specific cardiovascular outcome data for each agent is warranted 1, 6.