Management Plan for Patients on Jardiance (Empagliflozin) 10mg
The standard management plan for patients on Jardiance (empagliflozin) 10mg should include regular monitoring of renal function, assessment for adverse effects, and continuation of the medication at the current dose unless specific clinical circumstances warrant dose adjustment or discontinuation. 1
Dosing and Administration
- Empagliflozin 10mg is the standard starting dose, taken once daily in the morning with or without food 1
- The dose may be increased to 25mg once daily if needed for additional glycemic control in patients who tolerate the 10mg dose well 1
- No dose adjustment is required for patients with mild to moderate hepatic impairment 2
Renal Function Monitoring
- Assess renal function before initiating empagliflozin and periodically thereafter 1
- For patients with eGFR ≥45 mL/min/1.73m², no dose adjustment is required 3, 1
- For patients with eGFR <45 mL/min/1.73m², empagliflozin should not be used for glycemic control, though it may still provide cardiovascular and renal benefits 3, 2
- Discontinue empagliflozin if eGFR falls persistently below 45 mL/min/1.73m² 1
Monitoring for Adverse Effects
- Monitor for genital mycotic infections, which occur more frequently with SGLT2 inhibitors 2, 1
- Assess for signs and symptoms of urinary tract infections 1
- Watch for volume depletion, especially in elderly patients or those on concurrent diuretic therapy 2, 1
- Monitor for ketoacidosis, particularly during illness, reduced oral intake, or fluid losses 2, 1
- Check for hypoglycemia, especially if the patient is also on insulin or sulfonylureas 1, 4
Special Considerations
- Discontinue empagliflozin at least 3 days before scheduled surgery to reduce risk of ketoacidosis 2
- Consider reducing doses of concurrent diuretics if signs of volume depletion occur 2
- Be aware that empagliflozin may cause an initial "eGFR dip" of 3-5 mL/min/1.73m² that typically stabilizes after several weeks 3
- Monitor LDL cholesterol as empagliflozin may increase levels 1
Clinical Benefits Beyond Glycemic Control
- Empagliflozin provides cardiovascular benefits with reduction in the composite endpoint of cardiovascular death or hospitalization for heart failure 2, 5
- The medication offers renal protection by slowing eGFR decline in patients with diabetic kidney disease 2, 6
- Empagliflozin has been shown to reduce serum uric acid levels, with larger effects in patients with higher eGFR and without diabetes 6
Patient Education
- Advise patients about the risk of genital mycotic infections and urinary tract infections 1
- Instruct patients to seek medical attention if they experience symptoms of ketoacidosis (nausea, vomiting, abdominal pain, malaise) 3, 1
- Counsel patients about the importance of adequate hydration, especially during illness or in hot weather 1
- Inform patients that empagliflozin may cause modest weight loss and reduction in blood pressure as beneficial side effects 4, 5