Jardiance Starting Dose
The recommended starting dose of Jardiance (empagliflozin) is 10 mg once daily, taken in the morning, with or without food. 1
Dosing Algorithm
Initial dose: Start with 10 mg once daily for all adult patients with type 2 diabetes and adequate renal function 2, 1
Dose titration: The dose may be increased to 25 mg once daily if additional glycemic control is needed, though this higher dose provides no additional cardiovascular or renal benefit beyond the 10 mg dose 1
Critical Pre-Treatment Renal Assessment
Before initiating Jardiance, you must assess renal function 1:
- Do not start Jardiance if eGFR is below 45 mL/min/1.73 m² 2, 1
- Discontinue if eGFR falls persistently below 45 mL/min/1.73 m² during treatment 1
- The glucose-lowering efficacy decreases with declining renal function, though cardiovascular and kidney benefits are preserved at lower eGFR levels 3
Rationale for 10 mg Starting Dose
The 10 mg dose is specifically recommended because it was the lowest dose tested in cardiovascular and renal outcomes trials (EMPA-REG OUTCOME), and there is no evidence of a graded dose-response relationship for cardiovascular or renal protection. 2 This means starting at 10 mg provides full cardiovascular and renal benefits without requiring titration for these outcomes 2
Key Safety Precautions When Initiating
Concomitant medication adjustments: 2
- If HbA1c is well-controlled at baseline or the patient has frequent hypoglycemic events, reduce or stop sulfonylureas/glinides
- Consider reducing total daily insulin dose by approximately 20% when starting Jardiance
Volume status considerations: 2
- May cause intravascular volume contraction
- Consider stopping or reducing diuretic dose if applicable
- Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis