Jardiance Dosing and Safety Guidelines

Initial Dosing and Renal Considerations

The American College of Cardiology recommends starting Jardiance at a dose of 10 mg once daily for all adult patients with type 2 diabetes and adequate renal function 1
The American College of Cardiology advises against starting Jardiance if the estimated glomerular filtration rate (eGFR) is below 45 mL/min/1.73 m² 1
The glucose-lowering efficacy of Jardiance decreases with declining renal function, but cardiovascular and kidney benefits are preserved at lower eGFR levels 1

The American College of Cardiology suggests that the dose may be increased to 25 mg once daily if additional glycemic control is needed, but this higher dose provides no additional cardiovascular or renal benefit beyond the 10 mg dose 1
If HbA1c is well-controlled at baseline or the patient has frequent hypoglycemic events, the American College of Cardiology recommends reducing or stopping sulfonylureas/glinides 1

The 10 mg dose of Jardiance is specifically recommended because it was the lowest dose tested in cardiovascular and renal outcomes trials, and there is no evidence of a graded dose-response relationship for cardiovascular or renal protection 1
Starting at 10 mg provides full cardiovascular and renal benefits without requiring titration for these outcomes 1

The Kidney International guidelines recommend that Jardiance should not be initiated in patients with eGFR <45 mL/min/1.73 m², and genital mycotic infections occur in approximately 6% of patients taking SGLT2 inhibitors compared to 1% on placebo 2
Urinary tract infections are a potential adverse effect of Jardiance therapy 3
The risk of euglycemic ketoacidosis is increased, especially in patients with type 2 diabetes requiring insulin, and daily hygienic measures may reduce the risk of genital mycotic infections 2

The Kidney International guidelines state that the glucose-lowering efficacy of empagliflozin is reduced with declining eGFR, but kidney and cardiovascular benefits are preserved 2
For patients on insulin, maintaining at least low-dose insulin when starting Jardiance may reduce ketoacidosis risk, and Jardiance should be discontinued at least 3 days before planned surgery to prevent postoperative ketoacidosis 2, 3