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Jardiance
empagliflozin
Adult Dosing .
Dosage forms: TAB: 10 mg, 25 mg
diabetes mellitus, type 2
- [10-25 mg PO qam]
- Start: 10 mg PO qam; Info: hold tx at least 3 days before surgery/procedure if prolonged fasting
cardiovascular event risk reduction - DM type 2 patients with established cardiovascular disease
- [10 mg PO qam]
- Info: may incr. dose to 25 mg PO qam if additional glycemic control needed; hold tx at least 3 days before surgery/procedure if prolonged fasting
heart failure-associated risk reduction - heart failure patients
- [10 mg PO qam]
- Info: hold tx at least 3 days before surgery/procedure if prolonged fasting
kidney disease progression and cardiovascular-associated risk reduction - CKD patients with progression risk
- [10 mg PO qam]
- Info: hold tx at least 3 days before surgery/procedure if prolonged fasting
renal dosing
- [diabetes mellitus, type 2]
- eGFR <30: avoid use for glycemic control
- HD/PD: not defined
- [all other indications]
- eGFR >20: no adjustment; eGFR <20: not defined; Info: if eGFR <20 during tx, may continue 10 mg/day for cardiovascular or kidney benefit
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: TAB: 10 mg, 25 mg
diabetes mellitus, type 2
- [10 yo and older]
- Dose: 10-25 mg PO qam; Start: 10 mg PO qam; Info: hold tx at least 3 days before surgery/procedure if prolonged fasting
renal dosing
- [see below]
- renal impairment: not defined, consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy 2nd trimester
- pregnancy 3rd trimester
- breastfeeding
- diabetic ketoacidosis
- volume depletion
- eGFR <30 (diabetes mellitus tx use)
- caution: pregnancy 1st trimester
- caution: eGFR <60
- caution: hypotension
- caution: elderly patients
- caution: ketoacidosis risk
- caution: pancreatic disorder
- caution: fasting
- caution: febrile illness, acute
- caution: surgery
- caution: ketogenic diet
- caution: alcohol abuse
- caution: hyperlipidemia
- caution: GU infection history, recurrent
- caution: GU infection history, chronic
- caution: uncircumcised penis
- caution: diabetic foot ulcer
- caution: PVD
- caution: amputation history
Drug Interactions .
Overview
empagliflozin
SGLT2 inhibitor
- antidiabetic agent
- fluid/electrolyte loss
- hypotensive effects
Avoid/Use Alternative
- aldesleukin
- bexagliflozin
- canagliflozin
- dapagliflozin
- empagliflozin
- ertugliflozin
- lofexidine
- sotagliflozin
Monitor/Modify Tx
- acebutolol
- alclometasone topical
- alfentanil
- alfuzosin
- aliskiren
- alpelisib
- alprostadil intracavernous
- amantadine
- amcinonide topical
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- apomorphine
- apraclonidine ophthalmic
- aprocitentan
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- articaine
- asenapine
- asparaginase
- atazanavir
- atenolol
- avanafil
- azilsartan medoxomil
- benazepril
- berberine
- betamethasone
- betamethasone topical
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bisoprolol
- bortezomib
- brentuximab vedotin
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bumetanide
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- bupivacaine liposomal
- buprenorphine
- butorphanol
- cabergoline
- calaspargase
- candesartan cilexetil
- cannabis
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- carteolol ophthalmic
- carvedilol
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- denileukin diftitox
- desflurane
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- desogestrel (contraceptive)
- desonide topical
- desoximetasone topical
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- diazoxide
- dienogest (contraceptive)
- diflorasone topical
- dihydrocodeine
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- doxepin
- dronabinol
- drospirenone (contraceptive)
- duloxetine
- enalapril
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- enfortumab vedotin
- ensartinib
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- epinephrine
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- epoprostenol
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethanol injection
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- etripamil nasal
- everolimus
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- flaxseed
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- fluocinolone otic
- fluocinolone topical
- fluocinonide topical
- fluphenazine
- flurandrenolide topical
- fluticasone propionate topical
- fosamprenavir
- fosinopril
- foslevodopa
- fosphenytoin
- furosemide
- garlic
- gilteritinib
- ginkgo
- glimepiride
- glipizide
- glyburide
- goserelin
- guanfacine
- halcinonide topical
- halobetasol topical
- haloperidol
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydrocortisone
- hydrocortisone topical
- hydromorphone
- iloperidone
- iloprost
- imipramine
- inavolisib
- indapamide
- insulin
- irbesartan
- iron sucrose
- isocarboxazid
- isoflurane
- isoniazid
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- labetalol
- landiolol
- lanreotide
- leuprolide
- levobunolol ophthalmic
- levodopa
- levofloxacin
- levonorgestrel (contraceptive)
- levorphanol
- levothyroxine
- lidocaine
- liothyronine
- lisinopril
- lithium
- lopinavir/ritonavir
- lorlatinib
- losartan
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- lutetium Lu 177 dotatate
- magnesium sulfate
- maraviroc
- medroxyprogesterone (contraceptive)
- megestrol
- meperidine
- mepivacaine
- methadone
- methohexital
- methyldopa
- methylene blue injection
- methylprednisolone
- metolazone
- metoprolol
- midazolam
- milrinone
- milsaperidone
- minoxidil
- mirtazapine
- moexipril
- molindone
- mometasone topical
- morphine
- moxifloxacin
- nadolol
- nalbuphine
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nelfinavir
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- norelgestromin (contraceptive)
- norepinephrine
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- nortriptyline
- obinutuzumab
- octreotide
- ofloxacin
- olanzapine
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- palopegteriparatide
- paltusotine
- pasireotide
- pegaspargase
- peginterferon alfa 2a
- pentamidine
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenelzine
- phenobarbital
- phenoxybenzamine
- phentolamine
- phenylephrine
- phenytoin
- pindolol
- plozasiran
- pramipexole
- prazosin
- prednicarbate topical
- prednisolone
- prednisone
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- propranolol
- protriptyline
- pseudoephedrine
- quetiapine
- quinapril
- ramipril
- rasagiline
- remifentanil
- remimazolam
- repaglinide
- riociguat
- risperidone
- ritonavir
- ropinirole
- ropivacaine
- rotigotine transdermal
- sacrosidase
- sacubitril
- safinamide
- segesterone (contraceptive)
- selegiline
- selegiline transdermal
- sevoflurane
- sildenafil
- silodosin
- sirolimus albumin-bound
- sodium ferric gluconate complex
- somapacitan
- somatrogon
- somatropin
- sotalol
- sparsentan
- spironolactone
- sucralfate
- sufentanil
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- temsirolimus
- teprotumumab
- terazosin
- tesamorelin
- thalidomide
- thioridazine
- thiothixene
- thyroid
- timolol
- timolol ophthalmic
- tipranavir
- tizanidine
- tolcapone
- torsemide
- tramadol
- trandolapril
- tranylcypromine
- trazodone
- treprostinil
- triamcinolone
- triamcinolone topical
- triamterene
- trifluoperazine
- trimipramine
- triptorelin
- valsartan
- vamorolone
- vardenafil
- verapamil
- vorinostat
- vosoritide
- yohimbe
- ziprasidone
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- angioedema
- acute kidney injury
- ketoacidosis
- UTI, serious
- hypotension, orthostatic
- Fournier gangrene
- lower limb amputation risk
Common Reactions
- hypoglycemia (peds patients)
- UTI
- genital mycotic infection
- URI
- urination incr.
- dyslipidemia
- Hct incr.
- arthralgia
- nausea
- Cr incr.
Safety/Monitoring .
Monitoring Parameters
Cr at baseline, then periodically; BP; consider urine ketones if diabetes mellitus type 1 or ketoacidosis risk
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use in 2nd and 3rd trimesters, weigh risk/benefit in 1st trimester; inadequate human data available; risk of reversible adverse effects on renal development and maturation in 2nd and 3rd trimesters based on animal data at 13x MRHD and drug's mechanism of action; no known risk of teratogenicity in 1st trimester based on animal data at up to 128x MRHD
Lactation
Clinical Summary
avoid use while breastfeeding; inadequate human data available, though possible risk of adverse effects on infant renal development and maturation based on drug's mechanism of action; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for empagliflozin: liver; CYP450: none; UGT: 1A3, 1A8, 1A9, 2B7 substrate
Excretion: for empagliflozin: urine 54.4% (50% unchanged), feces 41.2% (majority unchanged); Half-life: 12.4h
Subclass: Diabetes: SGLT2 Inhibitors ; SGLT2 Inhibitors, Cardiovascular ; SGLT2 Inhibitors, Nephrological
Mechanism of Action
for empagliflozin: inhibits sodium-glucose cotransporter 2 (SGLT2), reducing glucose and sodium reabsorption, incr. urinary glucose excretion and sodium delivery to distal tubule; may reduce cardiac preload and afterload, downregulate sympathetic activity, incr. tubuloglomerular feedback, and decr. intraglomerular pressure
Formulary .
No Formulary Selected
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