Jardiance (Empagliflozin) Dosing Guidelines
Jardiance (empagliflozin) is administered as a 10 mg oral tablet taken once daily, with the standard starting dose being 10 mg daily for most patients. 1
Standard Dosing
- Empagliflozin is taken orally once daily at a dose of 10 mg, which is the standard starting dose for most patients with type 2 diabetes 1
- The medication can be taken at any time of day, as studies show no significant difference in effectiveness between morning and evening administration 2
- Jardiance can be taken with or without food 3
Dose Adjustments Based on Renal Function
- For patients with eGFR ≥20 ml/min/1.73 m², the standard 10 mg daily dose is recommended 1
- For patients with eGFR <45 ml/min/1.73 m², empagliflozin is not recommended for glycemic control, though it may still be used for cardiovascular or renal benefits 1
- For patients with eGFR <20 ml/min/1.73 m², empagliflozin should not be initiated 1
- Once initiated, empagliflozin can be continued at lower levels of eGFR until dialysis for cardiovascular and kidney benefits 1
Special Populations and Considerations
- In patients with heart failure with reduced ejection fraction (HFrEF), empagliflozin 10 mg daily is recommended regardless of diabetes status 1
- For patients with diabetic kidney disease and eGFR ≥20 ml/min/1.73 m², empagliflozin is recommended independent of A1C levels 1
- No dose adjustment is required for patients with mild to moderate hepatic impairment 1
- For patients with moderate hepatic impairment (Child-Pugh B), a reduced starting dose may be considered 1
Important Precautions
- Discontinue empagliflozin at least 3 days before scheduled surgery to reduce risk of ketoacidosis 1
- Monitor for genital mycotic infections, which occur more frequently with SGLT2 inhibitors (6% vs 1% with placebo) 1, 3
- Consider reducing diuretic doses in patients taking concurrent diuretics due to potential volume depletion 1
- Monitor for signs of ketoacidosis, especially during illness, reduced oral intake, or fluid losses 1
- Assess for urinary tract infections, which may occur more frequently with SGLT2 inhibitor therapy 1
Clinical Benefits Beyond Glycemic Control
- Empagliflozin provides cardiovascular benefits with a 26% reduction in the composite endpoint of cardiovascular death or hospitalization for heart failure 1, 4
- The medication offers renal protection by slowing eGFR decline in patients with diabetic kidney disease 1, 4
- Empagliflozin typically leads to modest weight reduction (approximately 2 kg) and blood pressure reduction (systolic ~4 mmHg, diastolic ~2 mmHg) 3
Empagliflozin's unique mechanism of inhibiting glucose reabsorption in renal tubules provides benefits beyond glycemic control, making it particularly valuable for patients with type 2 diabetes who have established cardiovascular disease or kidney disease 4.