Can Jardiance (Empagliflozin) be switched to Ozempic (Semaglutide)?

Can Jardiance Be Switched to Ozempic?

Yes, you can switch from Jardiance (empagliflozin) to Ozempic (semaglutide), but the better approach is to use both medications together rather than switching, as they provide complementary cardiovascular and renal benefits through different mechanisms. 1, 2

Combination Therapy is Preferred Over Switching

• The American Diabetes Association and European Association for the Study of Diabetes recommend using SGLT2 inhibitors (like Jardiance) and GLP-1 receptor agonists (like Ozempic) together for patients with type 2 diabetes and established cardiovascular disease or high cardiovascular risk. 2

• Both medication classes have proven cardiovascular benefits but work through different mechanisms—combining them provides additive benefits for glycemic control, cardiovascular protection, and kidney disease prevention. 1, 2

• Emerging data suggest that using both classes together provides additional cardiovascular and kidney outcomes benefits beyond either agent alone. 1

• The combination can provide more robust HbA1c reduction than either agent alone, with GLP-1 RAs typically lowering HbA1c by 1.1-1.5% and SGLT2 inhibitors providing additional reductions. 2

When Switching is Appropriate

If you must switch rather than combine (due to cost, tolerability, or patient preference), consider these factors:

Cardiovascular Disease Priority

• Both Jardiance and Ozempic reduce major adverse cardiovascular events (MACE), but recent evidence suggests semaglutide may have a slight advantage over empagliflozin for stroke prevention specifically. 3
• Semaglutide reduced stroke risk by 38% compared to empagliflozin (HR 0.62, CI 0.43-0.89), though overall composite outcomes were similar. 3
• Both medications are Class I, Level A recommendations for patients with type 2 diabetes and peripheral arterial disease to reduce cardiovascular events. 1

Heart Failure Priority

• If heart failure is the primary concern, keep Jardiance rather than switching to Ozempic. 1, 2
• SGLT2 inhibitors like empagliflozin have superior evidence for reducing hospitalization for heart failure in both HFrEF and HFpEF, including in patients without diabetes. 1
• Semaglutide has shown benefit in HFpEF with obesity but the evidence is less robust than for SGLT2 inhibitors. 1

Chronic Kidney Disease Priority

• For advanced CKD (eGFR <30 mL/min/1.73 m²), Jardiance has stronger evidence for kidney protection. 1
• Empagliflozin, canagliflozin, and dapagliflozin improved CKD outcomes and reduced cardiovascular events in persons with moderate to severe CKD. 1
• Both medication classes show beneficial effects on kidney function, but dedicated renal outcomes studies favor SGLT2 inhibitors. 1

Weight Loss Priority

• If weight loss is the primary goal, switch to Ozempic (semaglutide), as it has the highest weight loss efficacy among glucose-lowering agents. 1
• Semaglutide and tirzepatide currently have the highest weight loss efficacy among agents approved for glycemic management. 1

Practical Switching Protocol

If proceeding with a switch rather than combination:

• Start Ozempic at 0.25 mg weekly while continuing Jardiance, then discontinue Jardiance after 3-4 weeks once Ozempic is established. 2

• This overlap prevents a gap in cardiovascular protection and allows monitoring for side effects from the new medication. 2

• Monitor for hypoglycemia if the patient is also on sulfonylureas or insulin—consider reducing sulfonylurea dose or decreasing total daily insulin by approximately 20%. 2, 4

• Be aware that semaglutide may cause gastrointestinal side effects (nausea, vomiting) that can be mitigated by slow dose titration. 1

• Monitor for volume depletion when discontinuing Jardiance, as patients may have adapted to its diuretic effect. 2

Critical Contraindications Before Switching to Ozempic

• Avoid semaglutide in patients with personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia type 2 (MEN2). 4
• Active gallbladder disease, history of gastroparesis, and recent heart failure decompensation are also contraindications. 4
• No pretreatment measurement of calcitonin, pancreatic lipase, or amylase is routinely performed in clinical practice, though disease history assessment is important. 5

Bottom Line Algorithm

Use this decision tree:

1. Patient has heart failure → Keep Jardiance, add Ozempic if needed for glycemic control or weight loss 1, 2

2. Patient has advanced CKD (eGFR <30) → Keep Jardiance, consider adding Ozempic 1

3. Patient needs maximum weight loss → Switch to Ozempic or add it to Jardiance 1

4. Patient has ASCVD without heart failure → Use both medications together for complementary protection 2

5. Cost or access issues prevent combination → Ozempic provides broader benefits for most patients, but Jardiance is superior for heart failure 1, 3