Can Jardiance (Empagliflozin) be added to Glipizide and Trulicity (Dulaglutide)?

From the Guidelines

Yes, Jardiance (empagliflozin) can be added to a regimen that includes glipizide and Trulicity (dulaglutide) for treating type 2 diabetes, as supported by the most recent evidence from 1. This combination represents three different medication classes working through complementary mechanisms: Jardiance is an SGLT2 inhibitor that increases glucose excretion through the kidneys, glipizide is a sulfonylurea that stimulates insulin release from the pancreas, and Trulicity is a GLP-1 receptor agonist that improves insulin secretion and reduces glucagon. When adding Jardiance, the typical starting dose is 10 mg once daily, taken in the morning, as indicated in the study 1. This triple therapy can provide more comprehensive glucose control when dual therapy is insufficient to reach target A1C levels. However, this combination requires careful monitoring for hypoglycemia since both glipizide and Trulicity can lower blood sugar, and the addition of Jardiance may increase this risk, as noted in 1. Patients should be advised to monitor blood glucose levels more frequently after adding Jardiance and should be educated about recognizing and treating hypoglycemic episodes. Adequate hydration is also important as Jardiance increases urination, as mentioned in 1. It's also crucial to consider the potential benefits and risks of this combination, including the cardiovascular and kidney benefits associated with SGLT2 inhibitors and GLP-1 receptor agonists, as discussed in 1, 1, and 1. Overall, the decision to add Jardiance to a regimen of glipizide and Trulicity should be based on individual patient needs and medical history, with careful consideration of the potential benefits and risks, as emphasized in 1 and 1.

From the FDA Drug Label

Add-On Combination Therapy with Metformin and Sulfonylurea A total of 666 patients with type 2 diabetes participated in a double-blind, placebo-controlled study to evaluate the efficacy and safety of JARDIANCE in combination with metformin plus a sulfonylurea Patients with inadequately controlled type 2 diabetes on at least 1500 mg per day of metformin and on a sulfonylurea, entered a 2 week open-label placebo run-in. At the end of the run-in, patients who remained inadequately controlled and had an HbA1c between 7% and 10% were randomized to placebo, JARDIANCE 10 mg, or JARDIANCE 25 mg Treatment with JARDIANCE 10 mg or 25 mg daily provided statistically significant reductions in HbA1c (p-value <0. 0001), FPG, and body weight compared with placebo

Key Points:

• JARDIANCE can be added to metformin and a sulfonylurea.
• The combination provided statistically significant reductions in HbA1c, FPG, and body weight compared to placebo.
• Glipizide is a sulfonylurea, and Trulicity is a GLP-1 receptor agonist, but the label does support the use of JARDIANCE with metformin and a sulfonylurea.
• However, there is no direct information about the combination of JARDIANCE with glipizide and Trulicity, but it can be added to metformin and a sulfonylurea. 2

From the Research

Combination Therapy with Jardiance, Glipizide, and Trulicity

• The combination of Jardiance (empagliflozin) with other glucose-lowering drugs, including glipizide, has been shown to be effective in reducing HbA1c levels and improving glycemic control in patients with type 2 diabetes 3.
• Trulicity (dulaglutide) is a GLP-1 receptor agonist that has been shown to have additive effects when combined with SGLT2 inhibitors, such as Jardiance, in lowering HbA1c levels, systolic blood pressure, and body weight 4.
• The combination of SGLT2 inhibitors and GLP-1 receptor agonists has been shown to have potential benefits in reducing major cardiovascular events and renal decompensation 5, 4.
• However, the specific combination of Jardiance, glipizide, and Trulicity has not been directly studied in the provided evidence.

Potential Benefits and Risks

• The combination of Jardiance and Trulicity may have additive effects on lowering HbA1c levels, systolic blood pressure, and body weight, as well as reducing major cardiovascular events and renal decompensation 5, 4.
• However, the combination of Jardiance with glipizide may increase the risk of hypoglycemia, as glipizide is a sulfonylurea that can cause hypoglycemia 3.
• The combination of Jardiance with Trulicity may also increase the risk of gastrointestinal side effects, such as nausea and vomiting, as both drugs can cause these side effects 6, 4.

Clinical Considerations

• The decision to add Jardiance to a regimen of glipizide and Trulicity should be based on individual patient factors, such as glycemic control, cardiovascular risk, and renal function 7, 6.
• Patients should be closely monitored for potential side effects, such as hypoglycemia and gastrointestinal symptoms, and the dosage of each drug should be adjusted as needed to minimize these risks 3, 6.