Jardiance (Empagliflozin) Dosing for Adults with Type 2 Diabetes
The recommended dosing for Jardiance (empagliflozin) in adults with type 2 diabetes is 10 mg once daily taken in the morning, with or without food, with the option to increase to 25 mg once daily if additional glycemic control is needed. 1, 2
Dosing Guidelines
Initial Dosing
- Start with 10 mg once daily, taken in the morning 1, 2
- Can be taken with or without food 1
- No dose titration is required for cardiovascular or renal risk reduction benefits 2
Dose Adjustment
- May increase to 25 mg once daily if additional glycemic control is needed 1, 2
- For patients with established cardiovascular disease or heart failure, 10 mg daily is sufficient for cardiovascular risk reduction benefits 2
Renal Function Considerations
Dosing Based on eGFR
- 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 2
- eGFR <30 mL/min/1.73 m²: Contraindicated 2, 1
- Dialysis patients: Contraindicated 2, 1
Monitoring
- Assess renal function before initiating Jardiance 1
- Discontinue Jardiance if eGFR falls persistently below 45 mL/min/1.73 m² 1
- Monitor renal function periodically during treatment 2
Special Considerations
Concomitant Medications
- If patient is already on insulin or sulfonylureas when starting empagliflozin, consider reducing doses of these agents to minimize hypoglycemia risk 2
- For patients on diuretics, monitor for signs of hypotension 2, 1
Timing of Administration
- Typically administered in the morning 2, 1
- Studies comparing morning versus evening administration showed no statistically significant differences in efficacy 3
Perioperative Management
- Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 2
Clinical Effects
- Reduces HbA1c by approximately 0.8% 2, 4
- Provides weight reduction (approximately 2 kg) 4
- Reduces blood pressure (systolic ~4 mmHg, diastolic ~2 mmHg) 4
- Offers cardiovascular protection as demonstrated in the EMPA-REG OUTCOME trial 5
Potential Adverse Effects
- Urinary tract infections 1
- Genital mycotic infections (more common in women) 1, 4
- Hypotension (especially in elderly, patients with renal impairment, or those on diuretics) 1
- Ketoacidosis (rare but serious) 1
- Acute kidney injury (monitor renal function) 1
- Increased LDL-C 1
Contraindications
- History of serious hypersensitivity reaction to empagliflozin 1
- Severe renal impairment (eGFR <30 mL/min/1.73 m²) 1
- End-stage renal disease or dialysis 1
Remember that Jardiance works by inhibiting glucose reabsorption in the renal tubules, providing an insulin-independent mechanism of lowering blood glucose, which makes it a valuable addition to the therapeutic options for managing type 2 diabetes 4, 6.