Resuming Jardiance (Empagliflozin) Post-Operatively
Jardiance (empagliflozin) should be restarted only once you are eating and drinking normally, typically 24-48 hours after surgery, and after confirming capillary ketones are less than 0.6 mmol/L if measured. 1
Perioperative Management of SGLT2 Inhibitors
SGLT2 inhibitors like Jardiance carry a significant risk of perioperative ketoacidosis, which can occur even with normal blood glucose levels (euglycemic diabetic ketoacidosis).
Pre-operative Considerations
- SGLT2 inhibitors should be omitted the day before and the day of surgery 1
- This creates a minimum 36-48 hour gap before surgery, which helps reduce but does not eliminate the risk of ketoacidosis
Post-operative Resumption Guidelines
For outpatient/day surgery:
- Resume Jardiance once eating and drinking normally (usually 24-48 hours after surgery) 1
- Ensure you're following normal diet before restarting
For inpatient surgery:
- Resume Jardiance once eating and drinking normally AND capillary ketones are <0.6 mmol/L 1
- Monitoring ketones is important as ketoacidosis can occur even with normal blood glucose levels
Risk Factors and Precautions
Increased Risk Situations
- Prolonged fasting periods
- Very low energy/liver reduction diets
- Dehydration
- Acute illness (including COVID-19) 2
Warning Signs of Ketoacidosis
- Nausea, vomiting, abdominal pain
- Generalized malaise
- Shortness of breath
- Signs of dehydration and metabolic acidosis 3
Important Considerations
- If you experience signs of severe metabolic acidosis, seek medical attention immediately, as ketoacidosis can occur even with blood glucose levels below 250 mg/dL 3
- Patients on SGLT2 inhibitors should receive written sick-day rules at discharge 1
- If you're undergoing a procedure that requires a very low-energy diet (like bariatric surgery), Jardiance should be stopped at the beginning of the diet 1
Special Situations
For patients with renal impairment:
- More careful monitoring is needed when restarting Jardiance
- The medication should not be used if eGFR is persistently less than 45 mL/min/1.73 m² 3
Remember that the risk of ketoacidosis exists on a continuum rather than having a defined threshold, so careful monitoring for signs of ketoacidosis is essential even after properly timing the resumption of your medication 1.