Jardiance 50mg Dosing Error
Jardiance (empagliflozin) does not come in a 50mg formulation—the maximum approved dose is 25mg once daily. 1
Available Formulations and Correct Dosing
The FDA-approved doses of Jardiance are:
- 10mg tablets (pale yellow, round)
- 25mg tablets (pale yellow, oval)
- No 50mg formulation exists 1
The recommended starting dose is 10mg once daily, taken in the morning with or without food. 1 In patients tolerating this dose who require additional glycemic control, the dose may be increased to the maximum of 25mg once daily. 1
Immediate Action Required
This patient needs immediate medication reconciliation to determine the actual dose being taken. Possible scenarios include:
Patient is taking two 25mg tablets daily (total 50mg): This represents a supratherapeutic dose with no additional benefit and potentially increased adverse effects. Reduce to 25mg once daily. 1
Prescription error or miscommunication: Verify the actual prescription and what the patient is physically taking.
Patient confusion about dosing: Confirm pill identification and actual daily intake.
Renal Function Assessment Critical
Before continuing any dose of Jardiance, assess eGFR immediately. 1
- Do not initiate if eGFR <45 mL/min/1.73 m² for glycemic control 1
- Discontinue if eGFR persistently <45 mL/min/1.73 m² 1
- For cardiovascular/renal protection, can continue down to eGFR ≥20 mL/min/1.73 m² at 10mg daily 2
Correct Dosing Algorithm
For type 2 diabetes with established cardiovascular disease:
- Start 10mg once daily 1
- May increase to 25mg once daily after tolerating initial dose if additional glycemic control needed 1
- Maximum dose: 25mg once daily 1
For heart failure with reduced ejection fraction:
- Fixed dose of 10mg once daily (the dose proven effective in EMPEROR-Reduced trial) 2, 3
- No titration needed for heart failure indication 2
Safety Monitoring After Dose Correction
Once corrected to appropriate dosing:
- Monitor for volume depletion/hypotension, especially if patient was on higher dose 1
- Recheck eGFR within 1-2 weeks after dose adjustment 2
- Assess for genital mycotic infections (6% incidence) 2
- Educate about withholding during acute illness (sick day rules) 4
- Withhold at least 3 days before major surgery to prevent euglycemic DKA 4, 2