What blood tests are required before starting Jardiance (Empagliflozin)?

Blood Tests Required Before Starting Jardiance (Empagliflozin)

Check renal function (serum creatinine with eGFR calculation) before initiating Jardiance, as this is the single most critical test that determines whether the drug can be safely started and guides dosing decisions. 1, 2

Essential Pre-Treatment Laboratory Tests

Renal Function Assessment (Mandatory)

• Serum creatinine with estimated glomerular filtration rate (eGFR) is required before starting empagliflozin 1, 2
• Do not initiate empagliflozin if eGFR <20 mL/min/1.73 m² 2
• For glycemic control specifically, do not initiate if eGFR <45 mL/min/1.73 m² (though cardiovascular/renal protection benefits remain at eGFR 20-44 mL/min/1.73 m²) 2
• The Cockcroft-Gault formula or MDRD equation can be used for eGFR estimation 1

Glycemic Status Assessment

• Fasting plasma glucose and/or HbA1c should be measured to establish baseline glycemic control 1
• If fasting glucose >5.6 mmol/L (100 mg/dL) or HbA1c 5.7-6.4%, consider oral glucose tolerance test to clarify diabetes status 1
• This baseline is essential for monitoring glycemic response and adjusting other diabetes medications 1

Additional Recommended Tests

• Electrolytes (particularly potassium) to assess baseline status, as SGLT2 inhibitors can affect electrolyte balance 1
• Lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides) for comprehensive cardiovascular risk assessment 1
• Urinalysis with albumin-to-creatinine ratio (ACR) if CKD is suspected or present, as albuminuria influences treatment decisions 1
• Complete blood count as part of routine baseline assessment 1

Clinical Assessment Before Initiation

Volume Status Evaluation

• Assess for signs of volume depletion before starting empagliflozin, as SGLT2 inhibitors have diuretic effects 3, 2
• Consider reducing concurrent diuretic doses when initiating empagliflozin to prevent excessive volume depletion 3, 2
• Patients on diuretics, elderly patients, or those with low systolic blood pressure are at higher risk 3

Cardiovascular Assessment

• 12-lead ECG to identify atrial fibrillation, left ventricular hypertrophy, or prior myocardial infarction 1
• Blood pressure measurement using proper technique (correct cuff size, bare arm, supported at heart level, legs uncrossed) 1

Post-Initiation Monitoring Strategy

Early Follow-Up (1-2 Weeks)

• Recheck eGFR and creatinine within 1-2 weeks after starting empagliflozin 2
• Expect a transient eGFR decrease of 3-5 mL/min/1.73 m² within the first 2-4 weeks—this represents hemodynamic effect, not kidney injury 2
• Continue empagliflozin if creatinine increase is <30% from baseline with stable volume status 2

Ongoing Monitoring

• Recheck eGFR every 3 months if eGFR 45-59 mL/min/1.73 m² or if CKD stage 4 1
• Annual monitoring if eGFR ≥60 mL/min/1.73 m² 3
• Monitor for genital mycotic infections (occur in ~6% of patients) and urinary tract infections 3, 2

Common Pitfalls to Avoid

• Do not withhold empagliflozin solely because eGFR is <45 mL/min/1.73 m² if the indication is cardiovascular or renal protection rather than glycemic control—the protective benefits persist even when glucose-lowering efficacy is lost 2
• Do not confuse the expected hemodynamic eGFR dip (beneficial long-term) with true acute kidney injury 2
• Do not forget to educate patients to withhold empagliflozin during acute illness with reduced oral intake, fever, vomiting, or diarrhea to prevent diabetic ketoacidosis 3
• Do not overlook the need to withhold empagliflozin at least 3 days before major surgery or prolonged fasting 3, 2