Should You Decrease Your Jardiance (Empagliflozin) Dose?
No, you should not decrease your Jardiance dose based solely on routine circumstances—the standard dosing is 10 mg or 25 mg once daily, and dose reduction is not recommended in clinical practice. 1
Dosing Strategy for Jardiance
Jardiance does not require dose reduction; instead, the decision is whether to continue, discontinue, or maintain the current dose based on kidney function and clinical context. 2
Standard Dosing Approach
- If eGFR ≥30 mL/min/1.73 m²: Continue Jardiance at your current dose (either 10 mg or 25 mg daily) 2
- If eGFR falls below 30 mL/min/1.73 m²: It is reasonable to continue Jardiance even at this level, unless not tolerated or dialysis is initiated 2
- If eGFR <20 mL/min/1.73 m² or on dialysis: Jardiance is contraindicated 1
When to Temporarily Hold (Not Reduce) Jardiance
Temporarily discontinue Jardiance in specific high-risk situations, but do not reduce the dose: 2, 1
- Prolonged fasting due to acute illness or surgery 2
- Critical medical illness when at greater risk for ketosis 2
- Reduced oral intake or significant fluid losses (gastrointestinal illness, excessive heat exposure) 1
- Bowel preparation prior to colonoscopy 1
Kidney Function Monitoring
Monitor eGFR more frequently if kidney function is declining, but this does not necessitate dose reduction: 2, 1
- eGFR ≥60 mL/min/1.73 m²: Monitor at least annually 2
- eGFR 45-59 mL/min/1.73 m²: Monitor at least every 3-6 months 2
- eGFR 30-44 mL/min/1.73 m²: Monitor at least every 3-6 months 2
- eGFR <30 mL/min/1.73 m²: Use is not recommended for glucose lowering, but may be continued for cardiovascular/renal benefits if already established 2, 1
Expected eGFR Changes
A reversible decrease in eGFR when starting Jardiance is normal and generally not an indication to discontinue or reduce the dose. 2
- This hemodynamic effect reflects the drug's mechanism of action 2
- Do not stop Jardiance based solely on this initial eGFR dip 2
Important Clinical Considerations
Volume Status Management
If you are at risk for hypovolemia, adjust diuretics (not Jardiance) before starting or continuing therapy: 2
- Consider decreasing thiazide or loop diuretic doses rather than reducing Jardiance 2
- Monitor for symptoms of volume depletion and low blood pressure 2
Hypoglycemia Risk
If you are on insulin or sulfonylureas and meeting glycemic targets, reduce those medications (not Jardiance) to prevent hypoglycemia: 2
- Jardiance itself has a low inherent risk of hypoglycemia 3
- The glucose-lowering medications should be adjusted, not the SGLT2 inhibitor 2
Cardiovascular and Renal Benefits
Jardiance provides cardiovascular and renal protection independent of its glucose-lowering effects: 4, 5, 6
- Reduces cardiovascular death, heart failure hospitalization, and all-cause mortality 4
- Slows kidney function decline across the spectrum of kidney disease 6
- These benefits persist even when eGFR falls below 30 mL/min/1.73 m² 6
Common Pitfalls to Avoid
Do not reduce Jardiance dose due to: 2, 1
- Initial eGFR decline after starting therapy (this is expected) 2
- Mild kidney function impairment (eGFR 30-60 mL/min/1.73 m²) 2
- Concern about hypoglycemia (adjust other diabetes medications instead) 2
- Modest blood pressure reduction (this is a beneficial effect) 3
The only scenario requiring discontinuation (not dose reduction) is: 1