From the Guidelines
Switching a diabetic patient with normal renal function from glimepiride to Jardiance (empagliflozin) is recommended due to the cardiovascular and renal protection benefits provided by Jardiance, as evidenced by the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1. The patient's normal renal function is a crucial factor in this decision, as Jardiance is not recommended for patients with eGFR below 45 mL/min/1.73m² for glycemic control 1. The typical starting dose for Jardiance is 10mg once daily, which can be increased to 25mg if needed, but no further dose titration is needed for CV or renal risk reduction 1. When making this switch, it's essential to monitor blood glucose closely during the transition period, as the patient may need temporary insulin or additional medication adjustments, and consider stopping or reducing diuretic dose if applicable to prevent intravascular volume contraction 1. Patients should be educated about potential side effects of Jardiance, including genital mycotic infections, urinary tract infections, and the rare but serious risk of diabetic ketoacidosis, and the possibility of increased risk of bone fractures and lower limb ulcerations and soft tissue infections 1. Additionally, the 2022 guideline recommended use of SGLT2 inhibitors, such as empagliflozin, for kidney/heart failure outcomes in patients with eGFR 25–45 mL/min/1.73 m² 1. However, since the patient has normal renal function, the benefits of Jardiance, including weight loss and lower risk of hypoglycemia, make it a suitable alternative to glimepiride. Key considerations for the switch include:
- Monitoring blood glucose levels during the transition period
- Educating patients about potential side effects
- Considering the patient's individual needs and medical history
- Starting with the recommended dose of 10mg once daily and adjusting as needed.
From the FDA Drug Label
Empagliflozin pharmacokinetics were similar with and without coadministration of metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin, verapamil, ramipril, and simvastatin in healthy volunteers and with or without coadministration of hydrochlorothiazide and torsemide in patients with type 2 diabetes Empagliflozin had no clinically relevant effect on the pharmacokinetics of metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin, digoxin, ramipril, simvastatin, hydrochlorothiazide, torsemide, and oral contraceptives when coadministered in healthy volunteers JARDIANCE has been studied as monotherapy and in combination with metformin, sulfonylurea, pioglitazone, linagliptin, and insulin.
The patient can be switched to Jardiance (Empagliflozin) from Glimipride (Glimepiride) as Empagliflozin has been studied in combination with sulfonylurea (the class of medications that includes Glimepiride). Additionally, Empagliflozin has no clinically relevant effect on the pharmacokinetics of Glimepiride when coadministered. However, the decision to switch should be made with caution and under the guidance of a healthcare professional, considering the individual patient's needs and medical history 2, 2.
- Key considerations:
- Efficacy and safety of Jardiance in combination with sulfonylurea
- No clinically relevant effect on Glimepiride pharmacokinetics
- Individual patient needs and medical history
- Switching decision: should be made under the guidance of a healthcare professional.
From the Research
Patient Profile
- Diabetic patient with normal renal function
- Currently taking Glimipride (Glimepiride)
Considerations for Switching to Jardiance (Empagliflozin)
- Empagliflozin is an SGLT2 inhibitor that has been shown to have protective effects on the kidneys and heart, even in patients with preserved renal function 3
- Compared to glimepiride, empagliflozin has been shown to have a lower risk of hypoglycemia and weight gain, and may also have beneficial effects on blood pressure and cardiovascular risk factors 4
- Empagliflozin has been shown to reduce the risk of cardiovascular events, including cardiovascular death, and may also have nephroprotective effects 5
Potential Benefits of Switching to Empagliflozin
- Improved cardiovascular outcomes
- Reduced risk of hypoglycemia and weight gain
- Potential nephroprotective effects
- Improved blood pressure control
Potential Risks and Considerations
- Increased risk of genital infections 6, 7
- Potential for decreased renal function in patients with impaired renal function, although this may not be a concern for patients with normal renal function 5
- Need for ongoing monitoring of renal function and cardiovascular risk factors
Comparison to Other SGLT2 Inhibitors
- Empagliflozin has been shown to have comparable cardiovascular effectiveness to other SGLT2 inhibitors, such as canagliflozin and dapagliflozin 6
- However, the choice of SGLT2 inhibitor may depend on individual patient factors, such as renal function and cardiovascular risk profile.