Diuretic Effect of Jardiance

Mechanism of Action

Jardiance (empagliflozin) has both diuretic and natriuretic effects through its mechanism of action as an SGLT2 inhibitor, causing diuresis through osmotic diuresis from glucosuria and natriuretic effect, according to the American College of Cardiology 1
The diuretic effect is most pronounced when blood glucose is elevated, as more glucose is filtered and excreted, and diminishes as blood glucose normalizes, as stated by the American College of Cardiology 1

Empagliflozin has potentially additive natriuretic effects when combined with loop diuretics, and patients should be advised of this interaction, as recommended by the American College of Cardiology 2
High-risk populations, such as elderly patients, those on concurrent diuretic therapy, patients with low blood pressure, those on low sodium diets, and patients with kidney problems, require careful monitoring due to the risk of volume depletion, according to the American College of Cardiology 2
Patients should be advised to watch for signs of volume depletion, such as orthostatic lightheadedness, dizziness, or feeling faint, especially when standing up, as recommended by the American College of Cardiology 2

The diuretic and natriuretic effects of empagliflozin contribute to blood pressure lowering, with reductions in systolic and diastolic blood pressure, as proposed by the American College of Cardiology 1, 3

The American College of Cardiology recommends not discontinuing or reducing diuretic therapy preemptively when initiating empagliflozin, as it is usually not necessary to alter concurrent diuretic therapy, as stated in the Mayo Clinic Proceedings 4