Recommended Dose of Empagliflozin for Heart Failure
The recommended dose of empagliflozin (Jardiance) for heart failure is 10 mg once daily, taken in the morning with or without food. 1
Dosing Guidelines
- Empagliflozin 10 mg once daily is the standard recommended dose for heart failure treatment, regardless of ejection fraction (HFrEF or HFpEF) 1, 2, 3
- The dose may be increased to 25 mg once daily if tolerated, though clinical evidence primarily supports the 10 mg dose for heart failure benefits 1
- Empagliflozin should be taken in the morning, with or without food 1
Renal Considerations
- Assessment of renal function is recommended prior to initiation and periodically thereafter 1
- Do not initiate empagliflozin if eGFR is less than 45 mL/min/1.73 m² 1
- No dose adjustment is needed for patients with eGFR ≥45 mL/min/1.73 m² 1
- Discontinue empagliflozin if eGFR falls persistently below 45 mL/min/1.73 m² 1
Clinical Evidence Supporting Efficacy
- In the EMPEROR-Reduced trial, empagliflozin 10 mg daily reduced the composite risk of cardiovascular death or hospitalization for heart failure by 25% in patients with HFrEF (HR 0.75; 95% CI, 0.65-0.86) 2
- Benefits were observed regardless of diabetes status and were consistent across age groups 4, 2
- In the EMPEROR-Preserved trial, empagliflozin 10 mg daily reduced the composite risk of cardiovascular death or hospitalization for heart failure by 21% in patients with HFpEF (HR 0.79; 95% CI, 0.69-0.90) 3
- Clinical benefits of empagliflozin appear early, with significant effects observed as early as 12 days after treatment initiation 5
Additional Benefits
- Empagliflozin reduces the total number of heart failure hospitalizations 2, 3
- Patients on empagliflozin are 20-40% more likely to experience improvement in NYHA functional class 5
- Empagliflozin slows the annual rate of decline in estimated glomerular filtration rate compared to placebo (-0.55 vs -2.28 mL/min/1.73 m² per year) 2
- Empagliflozin reduces the need for diuretic intensification by approximately 33% 5
Special Considerations
- Correct volume depletion prior to initiation of empagliflozin to reduce risk of hypotension 1
- Monitor for signs and symptoms of hypotension after initiating therapy, especially in patients with renal impairment, elderly patients, those with low systolic blood pressure, or patients on diuretics 1
- The benefits of empagliflozin in heart failure appear to be a class effect of SGLT2 inhibitors and are independent of glucose-lowering effects 6
- Empagliflozin can be used in patients with heart failure regardless of diabetes status 6, 2
Common Adverse Effects
- Uncomplicated genital tract infections are more common with empagliflozin 2, 3
- Monitor for ketoacidosis, which can occur even with normal blood glucose levels 1
- Overall, empagliflozin is generally well-tolerated with an adverse event profile consistent with that seen in patients with type 2 diabetes 7