From the Guidelines
Jardiance (empagliflozin) can cause hyponatremia by increasing urinary glucose excretion through SGLT2 inhibition in the kidneys, leading to natriuresis and disrupting the body's electrolyte balance. When Jardiance blocks sodium-glucose cotransporters, it prevents the reabsorption of both glucose and sodium in the proximal tubule, resulting in increased sodium excretion in urine 1. This sodium loss can potentially result in hyponatremia (low blood sodium levels). Additionally, Jardiance causes osmotic diuresis as glucose in the urine draws water with it, which can further dilute sodium concentration in the blood. The medication also stimulates vasopressin release due to volume depletion, which promotes water retention while sodium continues to be lost, exacerbating hyponatremia.
Some key points to consider when prescribing Jardiance include:
- Monitoring patients for symptoms of hyponatremia such as headache, confusion, nausea, and weakness, especially in elderly individuals or those on diuretics or with kidney impairment 1.
- Maintaining adequate fluid and electrolyte balance is important while taking this medication.
- The risk of hyponatremia may be increased in patients with certain comorbidities, such as heart failure, which is a common indication for Jardiance use, as seen in studies such as EMPA-RESPONSE-AHF and EMPULSE 1.
- Healthcare providers should be aware of the potential for Jardiance to cause hyponatremia and take steps to mitigate this risk, including regular monitoring of electrolyte levels and adjustment of the medication regimen as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mechanism of Jardiance (Empagliflozin) Induced Hyponatremia
- Jardiance (Empagliflozin) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor, which promotes osmotic diuresis via urinary glucose excretion 2.
- The diuretic effect of empagliflozin can lead to volume depletion and a fall in blood pressure, especially during co-administration with other diuretics or antihypertensive drugs 3.
- Empagliflozin increases urinary glucose excretion, but does not seem to have a relevant impact on urine volume or electrolytes when used alone 4.
- However, when empagliflozin is co-administered with a diuretic agent, urinary glucose excretion remains increased, and the renin-angiotensin system is activated, which may lead to changes in electrolyte levels, including sodium 4.
Risk of Hyponatremia with Jardiance
- There is no direct evidence in the provided studies that Jardiance (Empagliflozin) causes hyponatremia.
- However, the diuretic effect of empagliflozin may increase the risk of volume depletion, which can lead to hyponatremia, especially in patients taking other diuretics or antihypertensive drugs 3, 5.
- A study on indapamide, a thiazide-like diuretic, found that it can induce hyponatremia as a side effect, highlighting the potential risk of diuretic-induced hyponatremia 6.
Interaction with Diuretics
- Empagliflozin was found to decrease the risk of hospitalization for heart failure or cardiovascular death, regardless of background diuretic status 5.
- However, empagliflozin was associated with an increased risk of volume depletion in patients taking diuretics, highlighting the need for careful monitoring of electrolyte levels and volume status in these patients 5.