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

The recommended dose of Jardiance (empagliflozin) for patients with type 2 diabetes is 10 mg once daily in the morning, taken with or without food, with the option to increase to 25 mg daily in patients who tolerate the medication well and need additional glycemic control. 1

Indications and Dosing

• Jardiance is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 1
• Jardiance is also indicated to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 1, 2
• The starting dose is 10 mg once daily, taken in the morning with or without food 1
• The dose may be increased to 25 mg once daily in patients who tolerate the medication and require additional glycemic control 1
• No dose titration is needed for cardiovascular or renal risk reduction benefits, as these are achieved at the 10 mg dose 2

Dose Modifications Based on Renal Function

• Assessment of renal function is recommended prior to initiation and periodically thereafter 1
• Jardiance should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m² 1, 2
• No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1.73 m² 1
• Jardiance should be discontinued if eGFR is persistently less than 45 mL/min/1.73 m² 1, 2

Contraindications

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

Clinical Benefits

• Moderate glucose-lowering effect: approximately 0.5% reduction in HbA1c compared to placebo in patients with baseline HbA1c of about 8% 3
• Cardiovascular benefits: 14% reduction in the composite outcome of MI, stroke, and cardiovascular death in patients with established cardiovascular disease 2, 4
• 38% relative risk reduction in cardiovascular death 4
• 35% relative risk reduction in hospitalization for heart failure 2, 4
• 32% relative risk reduction in death from any cause 4
• Benefits observed across the spectrum of heart failure risk 5

Cautions and Monitoring

• Correct volume depletion prior to initiation 1
• 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
• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 2
• If HbA1c is well-controlled at baseline or there is a history of frequent hypoglycemic events, consider reducing doses of sulfonylureas, glinides, or insulin (by approximately 20%) when starting therapy 2
• May contribute to intravascular volume contraction; consider stopping or reducing diuretic dose if applicable 2

Adverse Effects to Monitor

• Genital fungal infections 2, 1
• Urinary tract infections 2
• Euglycemic diabetic ketoacidosis (a serious life-threatening condition requiring urgent hospitalization) 2, 1
• Volume depletion and hypotension 1
• Potential hepatotoxicity 3

Special Considerations

• Empagliflozin offers the convenience of once-daily oral administration with a low inherent risk of hypoglycemia due to its insulin-independent mechanism of action 6
• Beyond glucose lowering, empagliflozin provides modest reductions in body weight and blood pressure 6
• The cardiovascular benefits of empagliflozin may be associated with shifts in gut microbiota and plasma metabolites 7
• Unlike canagliflozin, empagliflozin has not been associated with an increased risk of amputation or bone fractures 6