What is the equivalent dose of Brenzavvy (bexagliflozin) for an adult with type 2 diabetes who is taking Jardiance (empagliflozin) 10 mg daily?

Equivalent Dose Conversion: Jardiance to Brenzavvy

There is no established equivalent dose conversion between Jardiance (empagliflozin) 10 mg and Brenzavvy (bexagliflozin) because bexagliflozin is only available in a single 20 mg once-daily dose. 1, 2

Dosing Considerations

Jardiance (Empagliflozin) Current Regimen

• Your patient is taking 10 mg once daily, which is the standard starting dose for cardiovascular and renal benefits 1
• This dose provides proven cardiovascular mortality reduction and heart failure hospitalization benefits in major outcomes trials 3

Brenzavvy (Bexagliflozin) Available Dosing

• Only one dose exists: 20 mg once daily 2, 4, 5
• In phase 2 dose-finding studies, bexagliflozin was evaluated at 5 mg, 10 mg, and 20 mg doses, but only the 20 mg formulation was approved for clinical use 2
• The 20 mg dose demonstrated HbA1c reduction of approximately 0.45-0.80% compared to placebo 2, 4

Critical Clinical Considerations

Lack of Cardiovascular and Renal Outcomes Data

Bexagliflozin has no published cardiovascular or renal outcomes trial data, which is a major limitation compared to empagliflozin 5

• Empagliflozin 10 mg has proven benefits for:

  • 14% reduction in 3-point MACE 6
  • 38% reduction in cardiovascular death 6
  • 32% reduction in all-cause mortality 6
  • Significant heart failure hospitalization reduction 3
  • Renal protection benefits 7

• Bexagliflozin lacks these outcome data entirely 5

Comparative Efficacy to Other SGLT2 Inhibitors

• A head-to-head trial comparing bexagliflozin 20 mg to dapagliflozin 10 mg showed nearly identical HbA1c reduction (-1.08% vs -1.10%) and similar effects on fasting glucose, body weight, and blood pressure 8
• This suggests bexagliflozin 20 mg may have comparable glycemic efficacy to dapagliflozin 10 mg 8
• However, empagliflozin 10 mg and 25 mg show dose-dependent glycemic effects, with 25 mg providing superior HbA1c reduction 9, 10

Practical Recommendation

If switching is necessary, use bexagliflozin 20 mg once daily (the only available dose), but recognize this is not a true equivalent conversion. 2, 5

Important Caveats When Switching

1. Loss of proven cardiovascular and renal benefits: The patient will lose the established mortality and morbidity benefits of empagliflozin 5

2. Amputation risk: Bexagliflozin carries a warning for lower extremity amputation similar to canagliflozin, which may be a concern in patients with peripheral vascular disease 5

3. Similar adverse effect profile: Expect comparable rates of genital mycotic infections, urinary tract infections, and increased urination 4, 5

4. Renal dosing: Like empagliflozin, bexagliflozin's glycemic efficacy decreases with declining eGFR, though specific eGFR cutoffs for bexagliflozin initiation are not well-established in guidelines 7

When Bexagliflozin Might Be Considered

• Cost considerations only: If the patient cannot afford empagliflozin and bexagliflozin offers significant cost savings 5
• Temporary bridge therapy: Until generic SGLT2 inhibitors with proven outcomes become available 5

For patients with established cardiovascular disease, heart failure, or chronic kidney disease, empagliflozin, dapagliflozin, or canagliflozin should be strongly preferred over bexagliflozin due to their proven morbidity and mortality benefits. 3, 7, 3, 11