Can a patient with type 2 diabetes be on Ozempic (semaglutide) and Jardiance (empagliflozin) together?

Yes, patients with type 2 diabetes can and often should be on both Ozempic (semaglutide) and Jardiance (empagliflozin) together.

The American Diabetes Association and European Association for the Study of Diabetes explicitly recommend using SGLT2 inhibitors (like Jardiance) and GLP-1 receptor agonists (like Ozempic) together for patients with type 2 diabetes, particularly those with established cardiovascular disease or high cardiovascular risk, as they have complementary mechanisms of action that provide additive benefits. 1

Why This Combination Works

Complementary Mechanisms of Action

• Jardiance (empagliflozin) works by blocking glucose reabsorption in the kidneys, promoting urinary glucose excretion independently of insulin 2, 3
• Ozempic (semaglutide) stimulates insulin secretion and reduces glucagon secretion in a glucose-dependent manner, while also improving satiety and promoting weight loss 4
• These different mechanisms work synergistically without interfering with each other 1

Superior Glycemic Control

• The combination provides more robust HbA1c reduction than either agent alone 1
• GLP-1 receptor agonists like semaglutide typically lower HbA1c by 1.1-1.5%, with SGLT2 inhibitors providing additional reductions 1
• Both medications have minimal intrinsic risk of hypoglycemia when used together (unless combined with insulin or sulfonylureas) 4, 3

Cardiovascular and Renal Benefits

Cardiovascular Protection

• Empagliflozin reduces cardiovascular death by 38% and heart failure hospitalization in patients with type 2 diabetes and established cardiovascular disease 5
• Semaglutide is recommended by the American College of Cardiology for cardiovascular event reduction in patients with type 2 diabetes and cardiovascular disease or high cardiovascular risk 1
• Using both agents together provides complementary cardiovascular protection through different mechanisms 1

Kidney Protection

• The European Renal Association recommends SGLT2 inhibitors like empagliflozin to reduce progression of diabetic kidney disease 1
• Both medication classes have shown beneficial effects on kidney disease progression, with the combination potentially having complementary effects on kidney structure 1
• In patients intolerant to SGLT2 inhibitors, semaglutide alone has demonstrated significant renoprotective benefits 6

Practical Implementation Strategy

Initiation Approach

• Start with one agent first, then add the second after 3-4 weeks to better manage potential side effects and identify which medication may be causing any adverse effects 1
• This staged approach is recommended by the American College of Cardiology 1

Monitoring Requirements

• Monitor for hypoglycemia, especially if the patient is also taking sulfonylureas or insulin, as both medications can increase hypoglycemic potential when combined with these agents 4, 1
• Assess volume status and blood pressure regularly, as the combination may have additive effects on weight loss and blood pressure reduction 1
• Check renal function before initiating empagliflozin, as its efficacy decreases in patients with renal insufficiency 2

Important Safety Considerations

• Discontinue empagliflozin at least 3 days before planned surgery to prevent postoperative euglycemic ketoacidosis 5
• Stop SGLT2 inhibitors immediately if symptoms of ketoacidosis develop 5
• Be aware of the diuretic effect of SGLT2 inhibitors, which can lead to volume depletion in vulnerable patients 1, 2
• Mycotic genital infections occur more frequently with empagliflozin, especially in women 2

Common Pitfalls to Avoid

• Don't avoid this combination due to unfamiliarity—cardiovascular specialists should be champions for implementing these evidence-based therapies that reduce cardiovascular event rates 4
• Don't wait for metformin failure—while most trials enrolled patients on metformin, secondary analyses suggest cardiovascular benefits may be independent of baseline medication use 4
• Don't discontinue if HbA1c reaches target—these medications provide cardiovascular and renal benefits beyond glucose lowering, though increased vigilance for hypoglycemia is warranted when A1C is near target 4
• Don't overlook dose adjustments—empagliflozin should be used with caution in patients with renal insufficiency (GFR < 45 mL/min/1.73 m²) 5

Additional Benefits of Combination Therapy

Weight and Blood Pressure Effects

• Empagliflozin reduces body weight by approximately 2 kg and systolic blood pressure by approximately 4 mm Hg 2
• Semaglutide provides additional weight loss benefits through improved satiety 4
• The combination may have additive effects on both parameters 1

Durability and Tolerability

• Both medications are well tolerated, with most adverse events being mild or moderate in intensity 3
• The insulin-independent mechanisms of both drugs make them suitable for long-term use 2, 3