Jardiance (Empagliflozin) Dosing and Use in Type 2 Diabetes
The recommended dose of Jardiance (empagliflozin) for patients with type 2 diabetes is 10 mg orally once daily in the morning, taken with or without food, with the option to increase to 25 mg daily if needed for additional glycemic control. 1
Indications
- Jardiance is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 1
- It is also indicated to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 1
- Empagliflozin has demonstrated significant cardiovascular risk reduction in patients with established cardiovascular disease 2, 3
Dosing Algorithm
- Start with 10 mg once daily in the morning, with or without food 1
- The 10 mg daily dose provides optimal cardiovascular and glycemic benefits with a favorable safety profile 2
- If glycemic targets are not met with the 10 mg dose, may increase to 25 mg daily for additional glucose-lowering effects 2, 1
- No dose titration is needed specifically for cardiovascular or renal risk reduction benefits, as there is no evidence of a graded dose response for these outcomes 2
Special Considerations for Renal Function
- Assessment of renal function is recommended prior to initiation and periodically thereafter 1
- Do not initiate Jardiance in patients with eGFR less than 45 mL/min/1.73 m² 1, 2
- No dose adjustment is needed in patients with eGFR greater than or equal to 45 mL/min/1.73 m² 1
- Discontinue Jardiance if eGFR is persistently less than 45 mL/min/1.73 m² 1
- Jardiance is contraindicated in patients with severe renal impairment, end-stage renal disease, or on dialysis 1, 2
Clinical Benefits
- Beyond glycemic control, empagliflozin provides significant cardiovascular benefits, with a 38% relative risk reduction in cardiovascular death compared to placebo 3
- Empagliflozin reduces the risk of hospitalization for heart failure by 35% 3
- It also reduces all-cause mortality by 32% in patients with type 2 diabetes and established cardiovascular disease 3
- These cardiovascular benefits appear early (within months) and are largely independent of glycemic control 4, 5
- SGLT2 inhibitors like empagliflozin are recommended to reduce progression of diabetic kidney disease 6
Practical Management Considerations
- When initiating Jardiance, consider reducing or stopping sulfonylureas/glinides or reducing total daily insulin dose by approximately 20% to prevent hypoglycemia 2, 6
- In patients with volume depletion, correct this condition prior to initiation of Jardiance 1
- Discontinue Jardiance at least 3 days before planned surgery to prevent postoperative ketoacidosis 2, 6
- Monitor for signs and symptoms of hypotension after initiating therapy, particularly in patients with renal impairment, the elderly, patients with low systolic blood pressure, and those on diuretics 1
Adverse Effects and Monitoring
- Common adverse effects include genital infections 4, 3
- Monitor for symptoms of ketoacidosis, regardless of blood glucose levels 1
- Unlike canagliflozin, empagliflozin has not been associated with increased risk of amputation or bone fractures 4
- Empagliflozin causes intravascular volume contraction, which may lead to symptomatic hypotension 1
Patient Selection
- Empagliflozin provides consistent benefits across the spectrum of heart failure risk 7
- Particularly valuable for patients with type 2 diabetes and established cardiovascular disease or at high cardiovascular risk 2, 6
- Benefits extend to patients with diabetic kidney disease 6
Empagliflozin offers the convenience of once-daily oral administration with a low inherent risk of hypoglycemia due to its insulin-independent mechanism of action 4. Given its demonstrable cardioprotective and renoprotective benefits, it is worthy of preferential consideration in patients at high cardiovascular risk who require additional antidiabetic medication to attain their glycemic goals 4.