What is the proper dosing and administration of Jardiance (Empagliflozin)?

Proper Dosing and Administration of Jardiance (Empagliflozin)

Jardiance (empagliflozin) should be taken at a dose of 10 mg once daily in the morning, with or without food. 1

Dosing Guidelines

• Starting dose: 10 mg once daily in the morning
• Dose titration: May be increased to 25 mg once daily if additional glycemic control is needed 1, 2
• Administration timing: Take in the morning, with or without food 1
• Consistency: Take at approximately the same time each day for optimal effect

Renal Function Considerations

Renal function assessment is critical before starting Jardiance:

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment needed 1
• eGFR <45 mL/min/1.73 m²: Do not initiate Jardiance 1
• If eGFR falls persistently below 45 mL/min/1.73 m²: Discontinue Jardiance 1
• eGFR <30 mL/min/1.73 m²: Contraindicated 2
• Dialysis patients: Contraindicated 2

Special Considerations

Volume Status

• In patients with volume depletion, correct this condition prior to initiating Jardiance 1
• Consider reducing doses of concomitant diuretics to minimize hypotension risk 2

Concomitant Medications

• If patient is on insulin or sulfonylureas, consider reducing doses of these agents to minimize hypoglycemia risk 2

Perioperative Management

• Discontinue Jardiance at least 3 days before planned surgery to prevent postoperative ketoacidosis 2

Monitoring Recommendations

• Renal function: Assess before initiation and periodically thereafter 1
• Blood pressure: Monitor for hypotension, especially in patients on diuretics 2
• Signs of genital mycotic infections: More common side effect, especially in women 3
• Urinary tract infections: Slightly increased risk 3

Clinical Benefits

Jardiance provides multiple benefits beyond glycemic control:

• Reduces HbA1c by approximately 0.8% 3
• Promotes weight reduction (approximately 2 kg) 3
• Lowers blood pressure (systolic ~4 mmHg and diastolic ~2 mmHg) 3
• Provides cardiovascular protection, as demonstrated in the EMPA-REG OUTCOME trial 4

Common Pitfalls to Avoid

1. Starting in patients with inadequate renal function: Always check eGFR before initiating
2. Failure to monitor for volume depletion: Especially important in elderly patients or those on diuretics
3. Not addressing concomitant medications: Adjust insulin or sulfonylurea doses when starting Jardiance
4. Continuing medication before surgery: Remember to stop at least 3 days before planned procedures
5. Ignoring signs of genital infections: Educate patients about this common side effect

While one small study suggested that every-other-day dosing might be effective 5, the FDA-approved dosing is once daily, and this should be followed for optimal outcomes in terms of morbidity, mortality, and quality of life.