What is the recommended use and dosage of Jardiance (empagliflozin) for patients with type 2 diabetes?

Recommended Use and Dosage of Jardiance (Empagliflozin) for Type 2 Diabetes

Jardiance (empagliflozin) is recommended at a starting dose of 10 mg once daily in the morning, taken with or without food, for patients with type 2 diabetes as an adjunct to diet and exercise to improve glycemic control and reduce cardiovascular risk. 1, 2

Indications and Dosing

• Jardiance is indicated for adults with type 2 diabetes mellitus as:

  • An adjunct to diet and exercise to improve glycemic control 1, 2
  • To reduce the risk of cardiovascular death in patients with established cardiovascular disease 1, 2

• Dosage recommendations:

  • Starting dose: 10 mg once daily in the morning, with or without food 1, 2
  • Dose may be increased to 25 mg daily in patients who tolerate the medication well and need additional glycemic control 2
  • No dose titration is needed for cardiovascular or renal risk reduction benefits 1

Renal Considerations

• Assessment of renal function is recommended before initiating Jardiance and periodically thereafter 2
• Dosage adjustments based on renal function:
  • eGFR ≥45 mL/min/1.73 m²: No dose adjustment needed 1, 2
  • eGFR <45 mL/min/1.73 m²: Use is not recommended for glycemic control 1, 2
  • Jardiance should be discontinued if eGFR is persistently <45 mL/min/1.73 m² 2

Contraindications

• History of serious hypersensitivity reaction to empagliflozin 1, 2
• Severe renal impairment, end-stage renal disease, or dialysis 1, 2
• Pregnancy or breastfeeding 1

Cardiovascular Benefits

• Empagliflozin demonstrated significant cardiovascular benefits in the EMPA-REG OUTCOME trial: 3

  • 14% reduction in the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke 3
  • 38% reduction in cardiovascular death 3
  • 35% reduction in hospitalization for heart failure 3
  • 32% reduction in death from any cause 3

• These cardiovascular benefits were observed across the spectrum of heart failure risk, including patients at low-to-average, high, and very high risk for heart failure 4

Precautions and Monitoring

• Correct volume depletion prior to initiating Jardiance 2

• Monitor for signs and symptoms of:

  • Hypotension, especially in patients with renal impairment, elderly patients, those with low systolic blood pressure, or patients on diuretics 1, 2
  • Genital fungal infections 1
  • Urinary tract infections 1
  • Euglycemic diabetic ketoacidosis 1, 2

• Discontinue Jardiance at least 3 days before scheduled surgery to prevent postoperative ketoacidosis 1

• If HbA1c is well-controlled at baseline or there's a history of frequent hypoglycemic events, consider:

  • Weaning or stopping sulfonylurea or glinide medications 1
  • Reducing total daily insulin dose by approximately 20% when starting therapy 1

Special Considerations

• May contribute to intravascular volume contraction; consider stopping or reducing diuretic dose if applicable 1
• Empagliflozin has not been associated with increased risk of amputation or bone fractures, unlike some other SGLT2 inhibitors 5
• The cardiovascular benefits of empagliflozin may be associated with alterations in gut microbiota and plasma metabolites, which could contribute to its cardioprotective effects 6

Clinical Pearls

• The cardiovascular benefits of empagliflozin appear early (within months) and are not solely attributable to its glucose-lowering effects 7
• Empagliflozin's diuretic effect may contribute to its benefit in preventing heart failure in patients with cardiovascular disease 7
• The European Society of Cardiology recommends empagliflozin for patients with type 2 diabetes and cardiovascular disease or at very high/high cardiovascular risk to reduce cardiovascular events 1