Can you take Jardiance (empagliflozin) and glimepiride together?

Taking Jardiance (Empagliflozin), Glimepiride, and Metformin Together

Yes, you can take Jardiance (empagliflozin), glimepiride, and metformin together, but dose adjustment of glimepiride may be necessary to reduce the risk of hypoglycemia. 1

Safety Considerations for This Combination

• When adding an SGLT2 inhibitor like Jardiance to a regimen that includes a sulfonylurea like glimepiride, the dose of the sulfonylurea should be reduced by approximately 50% to minimize hypoglycemia risk 1
• The combination of SGLT2 inhibitors with sulfonylureas significantly increases the risk of hypoglycemia compared to using either agent alone 2
• In patients taking insulin or insulin secretagogues (like glimepiride), adding Jardiance requires careful monitoring of blood glucose levels to avoid hypoglycemic events 2

Dosing Adjustments

• For patients already on glimepiride who are adding Jardiance, consider reducing the glimepiride dose to at most 50% of the maximum recommended dose 1
• If already on a minimal dose of glimepiride, discontinuation might be considered when adding Jardiance, depending on current glycemic control 1
• Start with lower doses of sulfonylureas, such as glimepiride 1 mg, and titrate based on response 3

Monitoring Requirements

• More frequent blood glucose monitoring is recommended when initiating this combination therapy 2
• Watch for symptoms of hypoglycemia including headache, drowsiness, weakness, irritability, hunger, fast heartbeat, confusion, dizziness, or sweating 2
• Regular monitoring of renal function is important as both medications have dosing considerations based on kidney function 1

Efficacy of the Combination

• The combination of these medications addresses multiple pathophysiologic mechanisms of type 2 diabetes:
  • Metformin decreases hepatic glucose production and improves insulin sensitivity 1
  • Jardiance (empagliflozin) promotes urinary glucose excretion independent of insulin 1
  • Glimepiride stimulates insulin secretion from pancreatic beta cells 3
• This triple therapy can be effective when dual therapy with metformin and either agent alone is insufficient for glycemic control 1

Special Considerations

• Patients with renal impairment require careful assessment:
  • Glimepiride should be used with caution in renal impairment 3
  • Jardiance has reduced glucose-lowering efficacy when eGFR is <45 mL/min/1.73m² 1
• Patients should be informed about the risk of genital mycotic infections with Jardiance and advised on proper hygiene 1
• The risk of euglycemic diabetic ketoacidosis with Jardiance, though rare in type 2 diabetes, should be discussed 2

Common Pitfalls to Avoid

• Failing to reduce the sulfonylurea dose when adding Jardiance, which significantly increases hypoglycemia risk 1, 4
• Not providing adequate patient education about recognizing and managing hypoglycemia 2
• Overlooking the need for sick-day management plans, especially with Jardiance, which may need to be temporarily discontinued during acute illness 1
• Ignoring renal function monitoring, which is crucial for dosing of all three medications 1

This triple combination therapy can be effective for glycemic control but requires careful management of hypoglycemia risk and appropriate patient education about potential side effects and monitoring requirements.