Jardiance (Empagliflozin) Use During Breastfeeding
Jardiance is not recommended during breastfeeding due to concerns about potential effects on infant kidney development and lack of human safety data. 1
FDA Labeling Guidance
The FDA label for Jardiance explicitly states that use is not recommended while breastfeeding based on several key concerns 1:
No human data exists regarding the presence of empagliflozin in human milk, its effects on breastfed infants, or its impact on milk production 1
Renal development concerns are paramount: Human kidney maturation occurs in utero and during the first 2 years of life, which overlaps with the typical breastfeeding period 1
Animal data shows accumulation in rat milk with a milk-to-plasma ratio reaching 5 at 8 hours post-dose, suggesting significant drug concentration in breast milk 1
Juvenile animal toxicity was demonstrated: Rats directly exposed to empagliflozin during kidney maturation developed renal pelvic and tubular dilatations 1
Clinical Decision-Making Framework
When a breastfeeding mother with diabetes requires treatment, consider this approach:
Preferred alternatives should be used instead of Jardiance 2:
- Insulin remains the gold standard and is compatible with breastfeeding, though postpartum insulin requirements drop approximately 34% below pre-pregnancy levels 2
- Monitor for overnight hypoglycemia risk, as breastfeeding may increase this risk and necessitate insulin dose adjustments 2
General diabetes management principles during lactation 2:
- Breastfeeding is strongly recommended for all individuals with diabetes, including those with gestational diabetes history 2
- The benefits of maintaining good glycemic control in the mother generally outweigh theoretical medication risks 2
- Insulin sensitivity increases dramatically in the postpartum period 2
Important Caveats
If Jardiance use is being considered despite FDA recommendations:
- Consult the Drugs and Lactation Database (LactMed) for the most current safety information 2
- Monitor the infant closely for unusual symptoms or changes in feeding patterns 2
- Be aware that most medications are compatible with breastfeeding, but Jardiance is specifically flagged as not recommended 2, 1
The critical concern is the potential for empagliflozin to affect postnatal renal development during a vulnerable period of kidney maturation 1. This risk, combined with the complete absence of human safety data, makes alternative diabetes medications strongly preferable 1, 3.