Jardiance (Empagliflozin) - Uses and Effects

What is Jardiance?

Jardiance is the brand name for the active ingredient empagliflozin, an oral medication belonging to the class of SGLT-2 inhibitors (sodium-glucose cotransporter-2 inhibitors). It is co-marketed by Boehringer Ingelheim and Eli Lilly and is available by prescription only. Jardiance is approved for use in adults with type 2 diabetes mellitus, for the reduction of cardiovascular risk, and for the treatment of chronic heart failure and chronic kidney disease.

Indications

• Type 2 diabetes mellitus: To improve blood sugar control in adults, as an adjunct to diet and exercise.
• Heart failure: To reduce the risk of cardiovascular death and hospitalization in adults with symptomatic chronic heart failure.
• Chronic kidney disease: To slow the progression of chronic kidney disease and reduce the risk of kidney failure.

Mechanism of Action

Empagliflozin works by selectively inhibiting the SGLT-2 transporter in the kidneys. This transporter is normally responsible for reabsorbing glucose from the urine back into the bloodstream. By blocking this transporter, more glucose is excreted through the urine, which lowers blood sugar levels. This mechanism is independent of insulin, making it effective even in advanced type 2 diabetes. Additionally, the increased excretion of glucose leads to a mild caloric loss, which can contribute to moderate weight reduction.

Dosage and Administration

Jardiance is available in two strengths: 10 mg and 25 mg film-coated tablets. The recommended starting dose is typically 10 mg once daily, taken in the morning, with or without food. The dose may be increased to 25 mg if additional blood sugar control is needed. The appropriate dosage is determined individually by the treating physician. Caution is advised in patients with impaired kidney function, as the glucose-lowering effect may be reduced.

Side Effects

Common Side Effects

• Urinary tract infections
• Genital yeast infections (candidiasis)
• Increased urination (polyuria)
• Thirst

Rare but Serious Side Effects

• Diabetic ketoacidosis: A rare but dangerous condition involving elevated ketone levels in the blood, which can occur even with moderate blood sugar levels.
• Fournier gangrene: A very rare but severe bacterial infection of the genital and perineal area.
• Hypotension: Low blood pressure, particularly in patients taking diuretics or those with volume depletion.
• Acute kidney injury: Rare, but possible in cases of dehydration.

Contraindications and Warnings

• Jardiance must not be used in patients with type 1 diabetes.
• Not suitable for patients with severe renal impairment (eGFR below 20 ml/min/1.73 m², depending on indication).
• Should not be used during pregnancy or breastfeeding.
• Caution is advised in elderly patients and those taking blood pressure-lowering medications.

Advantages Over Other Antidiabetic Medications

Compared to other blood sugar-lowering drugs, Jardiance offers additional cardiovascular and renal protective effects that have been demonstrated in major clinical trials such as the EMPA-REG OUTCOME trial. This landmark study showed that empagliflozin significantly reduced the risk of cardiovascular death, heart attack, and stroke in patients with type 2 diabetes and high cardiovascular risk.

References

1. Zinman B et al. - Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. New England Journal of Medicine, 2015. EMPA-REG OUTCOME Trial.
2. European Medicines Agency (EMA) - Jardiance: EPAR - Product Information. Available at: www.ema.europa.eu
3. American Diabetes Association - Standards of Medical Care in Diabetes 2024. Diabetes Care, 2024.