When is follow-up blood work required after initiating Jardiance (Empagliflozin)?

Follow-up Blood Work After Jardiance (Empagliflozin) Initiation

Renal function should be evaluated prior to initiation of Jardiance and monitored periodically thereafter, with more frequent monitoring recommended in patients with eGFR below 60 mL/min/1.73 m².

Recommended Monitoring Schedule

Initial Monitoring (First 1-2 Months)

• Renal function tests: Should be checked within 1-2 months after initiation 1
• Liver function tests (LFTs): Should be checked within 1-2 months after initiation
• Complete blood count (CBC): Should be checked within 1-2 months after initiation

Ongoing Monitoring

• Renal function tests: Every 3-4 months for patients with eGFR <60 mL/min/1.73 m², and every 6-12 months for those with normal renal function 1
• Liver function tests: Every 3-4 months initially, then periodically (e.g., every 6-12 months) if stable
• Blood pressure: Monitor regularly, especially during the first month of treatment 2

Special Monitoring Considerations

Based on Renal Function

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment required, standard monitoring 3
• eGFR <45 mL/min/1.73 m²: Not recommended for glycemic control, more frequent monitoring if used for other indications 3
• eGFR <30 mL/min/1.73 m²: Jardiance is contraindicated 3, 1

Additional Monitoring

• Signs of volume depletion: Monitor for symptoms of hypotension, especially in patients on diuretics or with baseline hypotension 1
• Signs of ketoacidosis: Monitor for symptoms even when blood glucose is not severely elevated (<250 mg/dL) 1
• Urinary tract infections: Monitor for symptoms as SGLT2 inhibitors increase risk 1
• Genital mycotic infections: Monitor for symptoms, especially in patients with history of recurrent infections 1

Situations Requiring More Frequent Monitoring

• Patients with renal impairment: More frequent monitoring of renal function is recommended 1
• Patients taking concomitant medications that may affect renal function: Such as diuretics, ACE inhibitors, ARBs, or NSAIDs 1
• Patients at risk for volume depletion: Elderly, those on diuretics, or with low systolic blood pressure 1
• During periods of reduced oral intake or fluid losses: Such as acute illness, fasting, gastrointestinal illness, or excessive heat exposure 1

Common Pitfalls and Caveats

• Delayed recognition of ketoacidosis: Blood glucose levels may be below those typically expected for diabetic ketoacidosis (often <250 mg/dL) 1
• Acute kidney injury: Can occur especially in settings of reduced oral intake or fluid losses; temporary discontinuation of Jardiance may be necessary 1
• Drug interactions: Nephrotoxic drugs can aggravate adverse effects and decrease hypoglycemic potency 4
• Volume depletion: The diuretic action can lead to volume depletion and fall in blood pressure, especially during co-administration with other diuretics or antihypertensive drugs 4

By following these monitoring guidelines, clinicians can optimize the safety and efficacy of Jardiance therapy while minimizing the risk of adverse events.