Empagliflozin
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Empagliflozin
Jardiance
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Summary
Common uses
Type 2 diabetes mellitus0, Heart failure with reduced ejection fraction0, Heart failure with preserved ejection fraction0, Chronic kidney disease (T2DM and non-T2DM)0
Pharmacy
Starting dose
10 mg PO once daily in the morning; may titrate to 25 mg for additional glycemic effect
Preparations
10 mg, 25 mg tablets
US FDA Max
25 mg/d
Pharmacology
Routes
Oral
Onset
Glycosuria within hours; HbA1c effect at 12 weeks; cardiovascular and renal benefits over months
Duration
24 hours
Half-life
~12.4 hours[1]
Bioavailability
High (oral; not affected by food, but typically given with the morning meal)[1]
Pregnancy
Avoid in second and third trimesters; fetal SGLT2 inhibition disrupts kidney development.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Empagliflozin selectively inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal tubule, blocking ~90% of filtered glucose reabsorption and producing dose-dependent glycosuria, natriuresis, and mild osmotic diuresis independent of insulin action.0 The cardiovascular and renal benefits (consistent across EMPA-REG, EMPEROR-Reduced/Preserved, and EMPA-KIDNEY) substantially exceed what HbA1c lowering predicts and are attributed to combined effects on preload, blood pressure, intraglomerular pressure via tubuloglomerular feedback, ketone-mediated cardiac metabolism, and reduced inflammation[1]. Genital mycotic infections, euglycemic DKA (especially with insulin reduction or fasting), and rare necrotizing fasciitis of the perineum (Fournier's) are the characteristic class adverse effects.
References
edit- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Jardiance (empagliflozin), Boehringer Ingelheim, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/204629s039lbl.pdf