Jardiance (Empagliflozin) for Weight Loss in Non-Diabetic Overweight Patients
Jardiance is not approved for weight reduction in non-diabetic patients and should not be used for this indication. 1
Current FDA-Approved Indications
Empagliflozin is approved exclusively for:
- Type 2 diabetes management with cardiovascular disease or high cardiovascular risk 1
- Chronic kidney disease to reduce progression 1
- Heart failure management regardless of diabetes status 2
None of these indications include weight loss as a standalone indication in non-diabetic patients. 1
Why This Matters for Non-Diabetic Weight Loss
The mechanism of empagliflozin works by blocking glucose reabsorption in renal tubules, which is insulin-independent 1. While this does produce modest weight loss in diabetic patients (approximately 2-3 kg over one year) 3, several critical issues emerge when considering use in non-diabetics:
Safety Concerns in Non-Diabetic Populations
- Variable effects based on body composition: In obese non-diabetic adults, empagliflozin's effect on triglycerides and metabolism differs significantly based on visceral adipose tissue mass, with potentially adverse metabolic effects in those with high visceral fat 4
- Risk of euglycemic ketoacidosis: This serious complication can occur even without diabetes, particularly in the perioperative period 5
- Genital and urinary tract infections: These occur at increased rates regardless of diabetes status 6
- Volume depletion and acute kidney injury: Risk increases when combined with other medications commonly used in overweight patients 5, 6
Recommended Alternatives for Non-Diabetic Weight Loss
First-line approach: Intensive lifestyle intervention with structured programs focusing on decreased caloric intake and increased physical activity, as demonstrated in the Diabetes Prevention Program and Look AHEAD trials 5, 1. These programs achieved 5-7% weight loss sustained over 3 years. 5
FDA-approved pharmacotherapy options when lifestyle intervention is insufficient:
- GLP-1 receptor agonists (semaglutide or liraglutide at weight loss doses) are specifically approved for weight management in non-diabetic patients 1
- These agents provide superior weight loss compared to empagliflozin (liraglutide achieves similar 2-3 kg loss but is actually approved for this indication) 3
Behavioral interventions: Structured dietary and exercise programs with at least 16 sessions in the first 24 weeks, followed by monthly maintenance 5, 1
Clinical Bottom Line
Using empagliflozin off-label for weight loss in non-diabetic patients exposes them to medication risks (infections, ketoacidosis, renal injury) without FDA approval or guideline support for this indication. 1, 6 The modest weight loss achieved (2-3 kg) 3 does not justify these risks when approved alternatives exist. Choose FDA-approved GLP-1 receptor agonists for weight loss or intensive lifestyle modification instead. 1