What is the proper dosing and administration of Jardiance (Empagliflozin)?

How to Administer Jardiance (Empagliflozin)

Dosing Regimen

Jardiance should be initiated at 10 mg once daily in the morning, taken with or without food, and may be increased to 25 mg once daily in patients who tolerate the initial dose. 1

• The medication can be taken at any time of day, though morning administration is recommended by the FDA label 1
• Pharmacokinetic studies show no clinically significant difference between morning and evening dosing, with bioequivalence maintained regardless of timing 2
• Food does not affect absorption, so Jardiance can be taken with or without meals 1

Renal Function Assessment Before Initiation

You must assess renal function (eGFR) before starting Jardiance and periodically thereafter. 1

eGFR-Based Initiation Criteria:

• Do NOT initiate if eGFR <45 mL/min/1.73 m² for glycemic control 1
• Initiate at standard dose (10 mg) if eGFR ≥45 mL/min/1.73 m² 1
• No dose adjustment needed for patients with eGFR ≥45 mL/min/1.73 m² 1

Special Populations with Lower eGFR:

• For children and adolescents (ages 10-17) with type 2 diabetes, empagliflozin can be initiated at 10 mg daily, with potential dose escalation to 25 mg if A1C remains ≥7.0% after 12 weeks 3
• The glucose-lowering efficacy decreases substantially with declining renal function, though cardiovascular and renal protective benefits may persist at lower eGFR levels 3, 4

Volume Status Correction

Correct volume depletion BEFORE initiating Jardiance. 1

• Assess for signs of intravascular volume depletion, particularly in elderly patients, those on diuretics, or patients with low systolic blood pressure 4
• This is critical to prevent hypotension and acute kidney injury upon initiation 1

Discontinuation Criteria

Discontinue Jardiance if eGFR falls persistently below 45 mL/min/1.73 m². 1

• "Persistently" means confirmed on repeat testing, not a single isolated value 1
• The exception is for non-glycemic indications (heart failure, chronic kidney disease), where continuation may be appropriate based on other guidelines, but the FDA label specifically addresses glycemic control 1

Perioperative Management

Withhold Jardiance at least 3 days before major surgery or procedures requiring prolonged fasting. 4

• This prevents the rare but serious risk of euglycemic diabetic ketoacidosis in the perioperative period 4
• Resume only after the patient has resumed normal oral intake and volume status is stable 4

Common Pitfalls to Avoid

• Do not start Jardiance in patients with active volume depletion without first correcting their volume status 1
• Do not ignore renal function monitoring—check eGFR before initiation and periodically during treatment 1
• Do not continue for glycemic control if eGFR drops below 45 mL/min/1.73 m² persistently 1
• Do not forget to counsel patients about genital mycotic infections, which occur in approximately 6% of patients (particularly women) versus 1% on placebo 4, 5

Dose Escalation Strategy

• Start with 10 mg once daily 1
• If additional glycemic control is needed and the patient tolerates the initial dose well, increase to 25 mg once daily 1
• In pediatric patients (ages 10-17), consider dose escalation from 10 mg to 25 mg at week 14 if A1C remains ≥7.0% at week 12 3