Jardiance

Jardiance contains the active ingredient empagliflozin and belongs to the class of SGLT2 inhibitors (gliflozins). It is used to treat type 2 diabetes mellitus in adults.

Empagliflozin lowers blood sugar: it causes excess sugar to be excreted in the urine. This mechanism is insulin-independent, meaning it also works when insulin production is declining.

In the EMPA-REG OUTCOME trial, Jardiance showed a cardiovascular protective effect, and it is also approved for the treatment of heart failure. It is manufactured by Boehringer Ingelheim.

Empagliflozin inhibits the sodium-glucose cotransporter 2 (SGLT2) in the kidney:

Mechanism of action:

• SGLT2 is responsible for the reabsorption of approx. 90% of the filtered glucose in the kidney
• Inhibiting this transporter causes glucose to be excreted in the urine
• Approx. 60-80 g of glucose are eliminated in the urine every day

Additional effects:

• Lowering of blood pressure (due to sodium and water loss)
• Weight loss (due to calorie loss via glucose in the urine)
• Cardiovascular protection
• Nephroprotective effect (kidney protection)

Insulin-independent: The mechanism of action is independent of insulin – the medication also works in advanced diabetes with reduced insulin production.

Jardiance is suitable for:

• Adults with type 2 diabetes as an adjunct to diet and exercise
• As monotherapy (if metformin is not tolerated)
• In combination with metformin, sulfonylureas, or insulin
• Diabetes patients with increased cardiovascular risk
• Patients with heart failure

Not suitable:

• Type 1 diabetes
• Severe renal impairment (eGFR < 20 ml/min/1.73 m² for diabetes therapy)
• Recurrent urinary tract infections or genital fungal infections
• Pregnancy and breastfeeding

Available strengths:

• 10 mg film-coated tablets
• 25 mg film-coated tablets

Recommended dosage:

• Starting dose: 10 mg once daily
• If needed and well tolerated: increase to 25 mg once daily

How to take:

• Once daily, preferably in the morning
• With or without meals
• Swallow the tablet whole, without chewing, with water

Important notes:

• Drink enough fluids (risk of dehydration)
• Watch for signs of urinary tract infections or genital fungal infection
• Regular kidney function checks
• Stop temporarily in case of illness, fever, or dehydration (after consulting a doctor)

Jardiance must not be taken in cases of:

• Hypersensitivity to empagliflozin

Type 1 diabetes: Jardiance should not be used in type 1 diabetes, as ketoacidosis occurred more often in studies.

Caution in cases of:

• Impaired kidney function (reduced efficacy at low eGFR)
• Tendency to urinary tract infections
• Tendency to genital fungal infections
• Elderly patients (>75 years – risk of dehydration)
• Concomitant diuretic therapy
• Increased risk of diabetic ketoacidosis

Pregnancy/breastfeeding: As a precaution, the use of Jardiance should be avoided during pregnancy. Jardiance should not be used during breastfeeding.

Very common (10% or more):

• Hypoglycemia (in combination with insulin/sulfonylureas)

Common (1-10%):

• Genital fungal infections (vaginal yeast infection, balanitis)
• Urinary tract infections
• Itching
• Constipation
• Increased urination (polyuria)

Uncommon:

• Dehydration
• Dizziness, drop in blood pressure

Rare but important:

• Diabetic ketoacidosis (even with normal or only slightly elevated blood sugar levels – atypical!)
• Fournier's gangrene (necrotizing fasciitis of the perineum – very rare)

Note: If you experience symptoms such as nausea, vomiting, abdominal pain, unusual tiredness, or shortness of breath, see a doctor immediately (suspected ketoacidosis).

Diuretics (water pills): Increased dehydration and lowering of blood pressure possible. Adjust the dose if necessary.

Insulin and sulfonylureas: Increased risk of hypoglycemia. A dose reduction may be necessary.

Other notes:

• No clinically relevant interactions via CYP enzymes
• Lithium levels may be affected