Jardiance (Empagliflozin) Contraindications
Jardiance is absolutely contraindicated in two situations: patients with a history of serious hypersensitivity reaction to empagliflozin, and patients with severe renal impairment (eGFR <30 mL/min/1.73 m²), end-stage renal disease, or those on dialysis. 1
Absolute Contraindications
- History of serious hypersensitivity reaction to empagliflozin or any excipients in Jardiance (including angioedema) 1
- Severe renal impairment with eGFR <30 mL/min/1.73 m² 1
- End-stage renal disease (ESRD) 2, 1
- Patients on dialysis 2, 1
Critical Situations Requiring Drug Discontinuation
Temporarily discontinue Jardiance in any setting of reduced oral intake or fluid losses to prevent acute kidney injury and ketoacidosis 1. This includes:
- Acute illness with fever, vomiting, or diarrhea 1
- Fasting or significantly reduced food intake 1
- Excessive heat exposure causing volume depletion 1
- At least 3 days before major surgery or procedures requiring prolonged fasting to prevent postoperative ketoacidosis 3, 4
Situations Requiring Extreme Caution (Relative Contraindications)
Renal Function Thresholds
- Do not initiate Jardiance when eGFR is persistently <45 mL/min/1.73 m² 1
- Use is not recommended when eGFR is persistently <45 mL/min/1.73 m² (though it may be continued if already established for cardiovascular/renal benefits) 3, 1
- More frequent renal monitoring is required when eGFR <60 mL/min/1.73 m² 1
Volume Depletion Risk Factors
Exercise extreme caution in patients predisposed to intravascular volume contraction 2, 3:
- Elderly patients 2, 3
- Patients with low systolic blood pressure 2, 3
- Patients on concurrent diuretics 2, 3
- Patients with chronic renal insufficiency 1
- Patients with congestive heart failure 1
High-Risk Clinical Scenarios
- History of chronic or recurrent genital mycotic infections (significantly increased risk of recurrence) 1
- Concurrent use of nephrotoxic drugs (ACE inhibitors, ARBs, NSAIDs) increases risk of acute kidney injury 1
- Patients at risk for ketoacidosis: those with reduced beta-cell function, reduced caloric intake, or increased insulin requirements due to acute illness 1
Important Monitoring Requirements
When initiating Jardiance, assess the following before starting 1:
- Baseline renal function (eGFR and serum creatinine) 1
- Volume status and blood pressure 3, 1
- History of genital or urinary tract infections 1
- Concurrent medications that may increase risk (diuretics, antihypertensives, nephrotoxic agents) 1
Monitor renal function periodically after initiation, with more frequent monitoring in patients with eGFR <60 mL/min/1.73 m² 1. Expect a transient increase in serum creatinine and decrease in eGFR after starting therapy, particularly in patients with hypovolemia 1.
Dose Adjustments with Concomitant Medications
Reduce doses of insulin or insulin secretagogues (e.g., sulfonylureas) when initiating Jardiance to minimize hypoglycemia risk 3, 1. The risk of hypoglycemia increases significantly when Jardiance is combined with these agents 1.