Jardiance (Empagliflozin) Does Not Require Tapering
No, you do not need to titrate Jardiance (empagliflozin) down or taper it off—you can stop it abruptly. 1
Evidence for Abrupt Discontinuation
The most definitive evidence comes from the EMPEROR trials withdrawal study, which specifically examined what happens when empagliflozin is stopped after years of continuous use. 1
- After a median of 16-26 months of treatment, 6,799 patients were prospectively withdrawn from empagliflozin in a blinded manner without any tapering protocol. 1
- The study demonstrated that stopping empagliflozin abruptly is safe, though the beneficial effects dissipate rapidly within approximately 30 days. 1
- Patients withdrawn from empagliflozin experienced reversal of the drug's physiological effects (increased glucose, body weight, blood pressure, NT-proBNP, and decreased hemoglobin) within 30 days, but no withdrawal syndrome or rebound adverse events occurred. 1
What Happens After Stopping
When empagliflozin is discontinued abruptly: 1
- The risk of cardiovascular death or heart failure hospitalization increases back toward baseline levels (hazard ratio 1.75,95% CI 1.20-2.54, P=0.0034). 1
- Kansas City Cardiomyopathy Questionnaire scores decline by 1.6 points compared to those continuing treatment (P<0.0001). 1
- Laboratory values return to pre-treatment levels within approximately 30 days, including increases in fasting glucose, body weight, systolic blood pressure, estimated glomerular filtration rate, NT-proBNP, uric acid, and serum bicarbonate. 1
Clinical Implications
The key takeaway is that empagliflozin's benefits persist during continuous treatment but disappear rapidly upon discontinuation—there is no evidence supporting gradual tapering, and abrupt cessation does not cause harm. 1
When to Consider Stopping
The American College of Cardiology recommends withholding empagliflozin at least 3 days before major surgery or procedures requiring prolonged fasting to prevent postoperative ketoacidosis. 2
Important Caveats
- Unlike medications such as beta-blockers or corticosteroids that require tapering to avoid rebound phenomena, SGLT2 inhibitors like empagliflozin do not cause physiological dependence. 1
- If discontinuation is necessary, patients should be counseled that their heart failure symptoms may worsen and their glucose control may deteriorate within weeks, but this represents loss of therapeutic benefit rather than a withdrawal syndrome. 1
- Consider restarting or switching to alternative guideline-directed medical therapy promptly if the indication for SGLT2 inhibitor therapy remains. 3