Jardiance (Empagliflozin) Uses and Indications
Jardiance (empagliflozin) is primarily indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus and to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease. 1
Primary Indications
- Jardiance is approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 2, 1
- Jardiance is indicated to reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease 2, 1
- Jardiance reduces the risk of hospitalization for heart failure in adults with type 2 diabetes 2
Cardiovascular Benefits
- In the EMPA-REG OUTCOME trial, empagliflozin demonstrated a 14% reduction in the composite outcome of myocardial infarction, stroke, and cardiovascular death 2, 3
- Empagliflozin showed a remarkable 38% reduction in cardiovascular death in patients with established cardiovascular disease 2
- Jardiance reduced hospitalization for heart failure by 35% compared with placebo, with benefits consistent in patients with and without a history of heart failure 2, 4
Renal Benefits
- Empagliflozin reduces the risk of worsening nephropathy in patients with type 2 diabetes and diabetic nephropathy with albuminuria 2
- In patients with prevalent kidney disease at baseline, empagliflozin reduced the risk of a prespecified renal composite outcome by 50% compared to placebo 2, 4
Dosing Information
- The recommended starting dose is 10 mg once daily, taken in the morning, with or without food 2, 5
- No dose titration is needed for cardiovascular or renal risk reduction benefits, as there is no evidence of a graded dose response for these outcomes 2, 5
- Dose increases to 25 mg daily may provide additional glucose-lowering benefits if glycemic targets are not met with the 10 mg dose 2, 5
Renal Function Considerations
- Empagliflozin is not recommended for glycemic control if eGFR is below 45 mL/min/1.73 m² 2, 5
- Empagliflozin is contraindicated in patients with severe renal impairment, end-stage renal disease, or on dialysis 2, 4
Important Precautions
- When initiating empagliflozin, consider reducing or stopping sulfonylureas/glinides or reducing total daily insulin dose by approximately 20% to prevent hypoglycemia 2, 5
- Discontinue empagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis 2, 5
- Monitor for genital fungal infections, urinary tract infections, and euglycemic diabetic ketoacidosis as potential adverse effects 2, 6
Limitations of Use
- Jardiance is not recommended for patients with type 1 diabetes 1
- Jardiance should not be used for the treatment of diabetic ketoacidosis 1
Mechanism of Action
- Empagliflozin works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the proximal renal tubules, which blocks glucose reabsorption and increases urinary glucose excretion 2, 3
- This insulin-independent mechanism makes it effective regardless of beta-cell function or insulin resistance and carries a low inherent risk of hypoglycemia 7, 8
Jardiance represents an important therapeutic option for patients with type 2 diabetes, particularly those with established cardiovascular disease or at high risk for cardiovascular events, offering benefits beyond glycemic control including cardiovascular and renal protection.