Recommended Dose of Empagliflozin (Jardiance) for HFrEF
The recommended dose of empagliflozin (Jardiance) for heart failure with reduced ejection fraction (HFrEF) is 10 mg once daily, taken in the morning with or without food. 1, 2
Dosing Guidelines
Empagliflozin for HFrEF follows a straightforward dosing approach:
- Initial dose: 10 mg once daily in the morning
- Target dose: 10 mg once daily (no titration required)
- Administration: Can be taken with or without food 1
Unlike many other heart failure medications that require gradual uptitration (such as beta-blockers, ACE inhibitors, or ARBs), empagliflozin is started and maintained at the same 10 mg dose. This simplifies the treatment regimen for patients with HFrEF.
Evidence Supporting This Dosing
The 2022 AHA/ACC/HFSA guidelines for heart failure management specifically list empagliflozin 10 mg once daily as both the initial and target dose for HFrEF 2. This dosing recommendation is based on pivotal clinical trials:
- The EMPEROR-Reduced trial demonstrated that empagliflozin 10 mg daily significantly reduced the risk of cardiovascular death or hospitalization for heart failure in patients with HFrEF 3, 4
- Benefits were observed regardless of background heart failure therapies and were consistent across various combinations of other guideline-directed medical therapies 3
- The beneficial effects of empagliflozin at this dose were seen early (as soon as 12 days after initiation) and maintained throughout treatment 4
Important Considerations for Use
Renal Function
- Assessment: Evaluate renal function before starting empagliflozin
- Contraindications: Do not initiate if eGFR is below 45 mL/min/1.73 m² 1
- Monitoring: Discontinue if eGFR falls persistently below 45 mL/min/1.73 m² 1
Volume Status
- Correct volume depletion before initiating empagliflozin
- Monitor for signs of hypotension, especially in patients:
- With renal impairment
- Who are elderly
- With low baseline systolic blood pressure
- Taking diuretics 1
Integration with Other HFrEF Medications
Empagliflozin should be used as part of comprehensive guideline-directed medical therapy for HFrEF, which typically includes:
- ACE inhibitor/ARB/ARNI
- Beta-blocker
- Mineralocorticoid receptor antagonist (MRA)
- SGLT2 inhibitor (empagliflozin 10 mg daily) 2, 5
Common Pitfalls to Avoid
Dose confusion: Unlike empagliflozin for diabetes (where dose may be increased to 25 mg), the HFrEF dose remains at 10 mg and does not require uptitration 1, 6
Renal function oversight: Failing to check baseline renal function or monitor for changes during treatment
Inadequate monitoring: Not watching for volume depletion or hypotension, especially during initiation
Inappropriate discontinuation: Stopping therapy prematurely due to minor, transient side effects rather than managing them
Missing the benefit in non-diabetic patients: Empagliflozin provides cardiovascular benefits in HFrEF regardless of diabetes status 3, 7
By maintaining patients on the recommended 10 mg daily dose of empagliflozin as part of comprehensive HFrEF therapy, clinicians can help reduce mortality, hospitalizations, and improve clinical stability in patients with heart failure with reduced ejection fraction.