Jardiance (Empagliflozin): Drug Classification
Jardiance is an SGLT2 (sodium-glucose cotransporter-2) inhibitor, an oral antidiabetic medication that works by blocking glucose reabsorption in the kidneys, causing glucose excretion in the urine. 1
Mechanism of Action
- Empagliflozin inhibits SGLT2 in the proximal renal tubule, which is responsible for approximately 90% of urinary glucose reabsorption. 2, 1
- By blocking this transporter, empagliflozin lowers the renal threshold for glucose and increases urinary glucose excretion by approximately 64-78 grams per day. 1
- This mechanism is insulin-independent, meaning it works regardless of β-cell function or insulin resistance. 2, 3
FDA-Approved Indications
- Improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise. 1
- Reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease. 4, 1
- Empagliflozin is NOT approved for type 1 diabetes or diabetic ketoacidosis. 1
Beyond Glucose Lowering: Cardiovascular and Renal Benefits
- Empagliflozin reduced cardiovascular death by 38% (HR 0.62,95% CI 0.49-0.77) and all-cause mortality by 32% (HR 0.68,95% CI 0.57-0.82) in patients with type 2 diabetes and established cardiovascular disease. 2
- Hospitalization for heart failure was reduced by 35% (HR 0.65,95% CI 0.50-0.85). 2
- The composite outcome of MI, stroke, or cardiovascular death was reduced by 14% (HR 0.86,95% CI 0.74-0.99). 2
- Renal protection: Empagliflozin reduced the risk of worsening nephropathy by 39-50% in patients with prevalent kidney disease. 2, 4
Additional Metabolic Effects
- Modest weight loss of approximately 2-2.5 kg through caloric loss via glucosuria. 3, 5
- Systolic blood pressure reduction of approximately 3-5 mmHg through osmotic diuresis and natriuresis. 2, 3
- Low intrinsic risk of hypoglycemia when used as monotherapy due to glucose-dependent mechanism. 2
Dosing
- Standard dose is 10 mg once daily, taken in the morning with or without food. 4
- A 25 mg dose is available but the 10 mg dose provides full cardiovascular and renal protective benefits without need for titration. 4, 6
Key Safety Considerations
- Contraindicated in severe renal impairment (eGFR <30 mL/min/1.73 m²), end-stage renal disease, or dialysis. 2, 1
- Should not be initiated if eGFR <45 mL/min/1.73 m² for glycemic control, though cardiovascular and renal benefits persist at lower eGFR levels. 4
- Increased risk of genital mycotic infections (especially in women) and urinary tract infections. 2, 4
- Potential for volume depletion, particularly in elderly patients, those on diuretics, or with low blood pressure. 2, 4
- Rare but serious risk of euglycemic diabetic ketoacidosis—discontinue at least 3 days before major surgery or prolonged fasting. 2, 4