When to increase Jardiance (Empagliflozin) to the next dose?

When to Increase Jardiance (Empagliflozin) to the Next Dose

Jardiance (empagliflozin) should be initiated at 10 mg once daily and may be increased to 25 mg once daily after 4 weeks if additional glycemic control is needed and the patient is tolerating the medication well. 1

Initial Dosing and Considerations

• Start with 10 mg once daily, taken in the morning with or without food 1
• Assess renal function before initiating therapy - do not start if eGFR is below 45 mL/min/1.73 m² 1
• Correct volume depletion prior to initiation if present 1
• Monitor for signs and symptoms of hypotension after starting therapy, especially in patients with renal impairment, elderly patients, those with low systolic blood pressure, or patients on diuretics 1

Dose Titration Protocol

• After 4 weeks on the 10 mg dose, assess glycemic control 1
• If additional glycemic control is required and the patient is tolerating the medication well (no significant adverse effects), increase to 25 mg once daily 1
• Continue to monitor renal function periodically - discontinue if eGFR falls persistently below 45 mL/min/1.73 m² 1

Factors to Consider Before Dose Escalation

• Ensure patient is tolerating the medication without significant adverse effects such as:
  • Genital mycotic infections 2
  • Volume depletion symptoms 1
  • Hypotension 1
  • Signs of ketoacidosis 1
• Verify that renal function remains stable with eGFR ≥45 mL/min/1.73 m² 1
• Assess if patient has achieved target glycemic control on the 10 mg dose - if targets are met, dose escalation may not be necessary 1

Special Populations

• For patients with diabetic kidney disease and eGFR ≥45 mL/min/1.73 m², no dose adjustment is needed when increasing to 25 mg 2
• For patients with heart failure, the cardiovascular benefits have been demonstrated with both doses, so dose escalation should be based primarily on glycemic needs 2, 3
• In elderly patients or those at risk for volume depletion, more cautious dose titration may be warranted 1

Monitoring After Dose Increase

• Reassess glycemic control 4-8 weeks after dose escalation 2
• Continue to monitor renal function and electrolytes 1
• Assess for any new or worsening adverse effects 1
• Monitor for signs of volume depletion or hypotension, especially if the patient is also taking diuretics 2, 1

Clinical Pearls

• The terminal elimination half-life of empagliflozin is 13.1 hours, which provides sustained glycemic control with once-daily dosing 4
• Beyond glycemic control, empagliflozin has demonstrated cardiovascular and renal benefits at both the 10 mg and 25 mg doses 3, 5
• Some patients may achieve adequate glycemic control with the 10 mg dose and not require escalation 6
• The decision to increase the dose should be based on individualized glycemic targets and medication tolerance 1

Remember that discontinuation is necessary if eGFR falls persistently below 45 mL/min/1.73 m², regardless of dose 1.