Jardiance (Empagliflozin) Dosing for Adults with Type 2 Diabetes
The recommended dose of Jardiance (empagliflozin) for adults with type 2 diabetes is 10 mg 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
Initial Dosing and Titration
- Start with 10 mg once daily in the morning, with or without food 1
- In patients tolerating the initial dose, may increase to 25 mg once daily if additional glycemic control is needed 1
- Administration can be in the morning or evening with similar pharmacokinetic and pharmacodynamic effects 2
Renal Function Considerations
- Assess renal function prior to initiation and periodically thereafter 1
- Do not initiate in patients with eGFR less than 45 mL/min/1.73 m² 1
- No dose adjustment is needed in patients with eGFR ≥45 mL/min/1.73 m² 1
- Discontinue Jardiance if eGFR falls persistently below 45 mL/min/1.73 m² 1
- Contraindicated in patients with severe renal impairment, end-stage renal disease, or on dialysis 1
Special Considerations
- In patients with volume depletion, correct this condition prior to initiation of Jardiance 1
- Monitor for signs and symptoms of hypotension after initiating therapy, particularly in:
Indications
- As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 1
- To reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease 1
Monitoring
- Regular assessment of renal function is recommended during treatment 1
- Monitor for signs of ketoacidosis, regardless of blood glucose levels 1
- Watch for genital mycotic infections and urinary tract infections, which are common adverse effects 1
- Monitor for volume-related adverse events, especially in elderly patients 1
Clinical Pearls
- Empagliflozin has shown cardiovascular protection in the EMPA-REG OUTCOME trial, with significant reductions in cardiovascular death, hospitalization for heart failure, and all-cause mortality 3
- The medication also demonstrates renal protective effects, including slower progression of kidney disease in patients with type 2 diabetes at high cardiovascular risk 4
- The efficacy of empagliflozin increases with higher levels of hyperglycemia but decreases in patients with renal insufficiency 5
- Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 6
Common Adverse Effects
- Genital mycotic infections (more common in women) 6, 1
- Urinary tract infections 6, 1
- Volume depletion and hypotension 1
- Euglycemic diabetic ketoacidosis (rare but serious) 1
By following these dosing guidelines and monitoring recommendations, clinicians can optimize the benefits of Jardiance while minimizing potential risks in adults with type 2 diabetes.