From the Guidelines
When managing medication changes for Empagliflozin (Jardiance), it is crucial to consider the patient's kidney function, as the drug should not be initiated with an eGFR below 30 mL/min/1.73m² for glycemic control or below 20 mL/min/1.73m² for heart failure, and its use is not recommended with an eGFR below 45 mL/min/1.73m² 1.
Key Considerations
- The standard dose of Empagliflozin is 10 mg once daily, and it can be taken in the morning with or without food.
- Before starting Empagliflozin, assess kidney function with an eGFR test, and monitor it periodically during treatment 1.
- When adding Empagliflozin to insulin or insulin secretagogues like sulfonylureas, consider reducing the insulin or secretagogue dose to minimize hypoglycemia risk.
- Patients should be advised to stay well-hydrated and report symptoms of urinary tract infections, genital mycotic infections, or volume depletion (dizziness, lightheadedness).
Dose Adjustments
- For patients with an eGFR between 30-44 mL/min/1.73m², the dose of Empagliflozin should be 10 mg daily 1.
- For patients with an eGFR between 15-29 mL/min/1.73m², initiation of Empagliflozin is not recommended, but it may be continued at a dose of 10 mg daily if tolerated for kidney and cardiovascular benefits until dialysis 1.
Important Interactions and Precautions
- Empagliflozin works by inhibiting SGLT2 in the kidneys, which increases urinary glucose excretion and lowers blood glucose levels independent of insulin action, making it effective for type 2 diabetes management while offering cardiovascular and renal benefits.
- Temporary discontinuation of Empagliflozin is recommended during periods of reduced oral intake or fluid losses (such as during illness with vomiting or diarrhea) to reduce the risk of ketoacidosis.
From the FDA Drug Label
Instruct patients to take JARDIANCE only as prescribed. If a dose is missed, it should be taken as soon as the patient remembers. Advise patients not to double their next dose Consider temporarily discontinuing JARDIANCE in any setting of reduced oral intake (such as acute illness or fasting) or fluid losses (such as gastrointestinal illness or excessive heat exposure); monitor patients for signs and symptoms of acute kidney injury. Renal function should be evaluated prior to initiation of JARDIANCE and monitored periodically thereafter.
When managing medication changes for Empagliflozin (Jardiance), key considerations include:
- Taking the medication as prescribed and not doubling the dose if one is missed
- Temporarily discontinuing use in settings of reduced oral intake or fluid losses
- Monitoring renal function before and during treatment
- Being aware of the potential for acute kidney injury, hypotension, and other adverse reactions
- Informing patients of the importance of adherence to dietary instructions, regular physical activity, and periodic blood glucose monitoring 2 2 2
From the Research
Considerations for Managing Medication Changes for Empagliflozin (Jardiance)
- When managing medication changes for Empagliflozin (Jardiance), it is essential to consider the patient's renal function, as the efficacy of empagliflozin decreases in patients with renal insufficiency 3.
- The risk of hypotension and volume depletion is low, but it should be carefully checked in more fragile and at-risk patients, especially during co-administration with other diuretics or antihypertensive drugs 3, 4.
- Empagliflozin may interact with nephrotoxic drugs, which can aggravate its adverse effects and decrease its hypoglycaemic potency 4.
- The diuretic action of empagliflozin can lead to volume depletion and a fall in blood pressure, especially during co-administration with other diuretics or antihypertensive drugs 4.
- Empagliflozin has been shown to reduce the risk of major adverse cardiovascular events and slow the progression of kidney disease in patients with type 2 diabetes at high cardiovascular risk 5, 6, 7.
- The adverse event profile of empagliflozin is similar across different subgroups of patients with diabetic kidney disease, including those with overt albuminuria and those without 7.
Key Factors to Consider
- Patient's renal function and risk of renal insufficiency
- Risk of hypotension and volume depletion
- Potential interactions with other medications, including nephrotoxic drugs and diuretics
- Cardiovascular and kidney benefits of empagliflozin in patients with type 2 diabetes at high cardiovascular risk
- Adverse event profile of empagliflozin across different subgroups of patients with diabetic kidney disease