What happens if I miss Jardiance (Empagliflozin) for 10 days?

What Happens If You Miss Jardiance (Empagliflozin) for 10 Days

Missing Jardiance (empagliflozin) for 10 days requires restarting the medication at your regular dose, as there are no specific dose adjustment protocols for missed SGLT2 inhibitors. 1

Effects of Missing Empagliflozin for 10 Days

• When empagliflozin is discontinued, its glucose-lowering effects will gradually diminish, potentially leading to elevated blood glucose levels over the 10-day period 2
• The cardiovascular and renal protective benefits of empagliflozin may be temporarily reduced during this interruption period 1
• The risk of developing diabetic ketoacidosis (DKA) is actually reduced during the period when the medication is not taken, as this is a potential adverse effect of the medication itself 3
• After 10 days without the medication, the diuretic effect will have subsided, potentially leading to fluid retention in patients who rely on this effect, especially those with heart failure 4

Restarting Empagliflozin After Missing Doses

• Unlike some medications that require dose titration after missed doses, empagliflozin can generally be restarted at the same dose (10 mg daily) without the need for retitration 1
• No specific guidelines exist for restarting SGLT2 inhibitors after missed doses, unlike the detailed protocols available for missed doses of contraceptives and other medications 4, 5
• Monitor for the following after restarting:
  • Initial "eGFR dip" of 3-5 mL/min/1.73m² which is expected and typically returns to baseline within weeks 4
  • Potential volume depletion, especially if taking concurrent diuretics 1
  • Genital mycotic infections, which can occur more frequently when starting or restarting SGLT2 inhibitors 1

Special Considerations

• If you have heart failure: Missing empagliflozin for 10 days may temporarily increase the risk of heart failure exacerbation, as the medication has been shown to reduce hospitalization for heart failure 4
• If you have chronic kidney disease: The kidney-protective effects will be temporarily paused, but no special restart protocol is needed 4
• If you have experienced illness, reduced food intake, or dehydration during the 10-day period: Be especially vigilant for signs of ketoacidosis when restarting, although the risk is low 3
• If you are taking other diabetes medications: You may have experienced higher glucose levels during the 10-day period, but this does not necessitate adjustment of your empagliflozin dose when restarting 4

Important Precautions When Restarting

• Do not double up on doses to make up for missed doses 5
• Ensure adequate hydration when restarting to minimize risk of volume depletion 1
• Monitor blood glucose more frequently for several days after restarting 4
• Be aware of symptoms of genital mycotic infections, which may occur more frequently when restarting therapy 1
• If you are scheduled for surgery within the next few days after restarting, inform your healthcare provider as empagliflozin should be discontinued at least 3 days before scheduled surgery 1

When to Seek Medical Advice

• If you experience symptoms of ketoacidosis after restarting (nausea, vomiting, abdominal pain, fatigue, difficulty breathing) even with normal blood glucose levels 3
• If you develop signs of volume depletion (dizziness, lightheadedness, weakness) 1
• If your blood glucose remains significantly elevated several days after restarting the medication 4
• If you have heart failure and notice worsening symptoms (increased shortness of breath, swelling, rapid weight gain) 4