Jardiance (empagliflozin), manufactured by Boehringer Ingelheim, is a prescription medication approved for treating heart failure. In August 2021, the FDA expanded its approval to include the treatment of heart failure with reduced ejection fraction (HFrEF). In 2022, the indication was further broadened to include heart failure with preserved ejection fraction (HFpEF), making Jardiance the first SGLT2 inhibitor with proven benefit across the full spectrum of ejection fractions. Jardiance was initially approved for the treatment of type 2 diabetes but has since gained momentum for use in heart failure.
Jardiance contains the active ingredient empagliflozin, which improves heart failure by inhibiting the kidneys’ sodium-glucose transporter 2 (SGLT-2), thereby increasing the elimination of glucose and sodium.
A basic understanding of Jardiance, how it works in heart failure, and potential side effects is crucial for managing heart failure symptoms and staying out of the hospital. This article offers a concise and practical overview of Jardiance indications, dosing, and possible side effects. Understanding these details is essential for maximizing the medication’s effectiveness and ensuring safe, long-term use.
What is Jardiance and How Is It Used?
Jardiance (empagliflozin) is an SGLT2 inhibitor, a class of medications that also includes Invokana (canagliflozin), Farxiga (dapagliflozin), and Steglatro (ertugliflozin). While these drugs share a similar mechanism, their FDA-approved uses and clinical trial results vary.
SGLT2 is an abbreviation for sodium-glucose co-transporter 2, a protein in the kidney responsible for reabsorbing filtered glucose and sodium from the kidneys back into the bloodstream. This increases the amount of glucose and sodium in the blood.
As an SGLT2 inhibitor, Jardiance blocks this protein, forcing sodium to be eliminated by the kidneys through urine, which lowers overall blood volume. This, in turn, helps lower blood pressure as well. The reduction in blood volume helps decrease the workload on the heart, which is particularly important for individuals with congestive heart failure who often suffer from fluid overload and elevated cardiac filling pressures. In addition to its diuretic-like effect, empagliflozin also improves cardiac metabolism and reduces oxidative stress, inflammation, and myocardial fibrosis—all of which contribute to improved heart structure and function over time.
How Jardiance Works in Heart Failure
Years after Jardiance was FDA-approved for type 2 diabetes, the FDA expanded the use of Jardiance for the treatment of congestive heart failure. Initially, Jardiance was approved by the FDA for use in patients with heart failure and reduced ejection fraction. However, about a year later, the FDA approved its use in heart failure patients regardless of the ejection fraction. This approval came after researchers observed an improvement in symptoms and clinical outcomes among patients with heart failure when Jardiance was used. Jardiance improves heart failure by increasing the amount of extra glucose and salt that is eliminated from the body, which lowers fluid retention. The elimination of excess salt and fluid reduces the pressure and stress on the heart, allowing it to function more efficiently.
Clinical trials such as EMPEROR-Reduced and EMPEROR-Preserved showed that Jardiance, whether used in patients with or without diabetes, significantly lowered the risk of cardiovascular death and reduced hospitalizations in individuals with heart failure. In EMPEROR-Reduced, patients with HFrEF taking Jardiance experienced a 25% reduction in the composite endpoint of cardiovascular death or hospitalization for heart failure. In EMPEROR-Preserved, patients with HFpEF saw a 21% relative risk reduction for the same outcome. These landmark trials firmly established Jardiance as a cornerstone of modern heart failure therapy.
Patients who have congestive heart failure, with or without diabetes, may benefit from Jardiance. The standard dose for Jardiance in congestive heart failure is 10 mg once daily.
Jardiance is typically used alongside other standard heart failure therapies, such as:
- Beta-blockers (e.g., metoprolol, carvedilol)
- Mineralocorticoid receptor antagonists (e.g., spironolactone, eplerenone)
- ARNIs (e.g., sacubitril/valsartan [Entresto])
- Loop diuretics (e.g., furosemide, torsemide)
Jardiance is not a replacement for these medications but works synergistically to improve outcomes. Many guideline-directed therapy combinations now include SGLT2 inhibitors as part of the first-line treatment for heart failure.
Jardiance vs Other SGLT2 Inhibitors
Farxiga vs Jardiance
Jardiance (empagliflozin) and Farxiga (dapagliflozin) are both SGLT2 inhibitors. Because they are within the same drug class, they work very similarly and provide similar benefits. However, there are some key distinctions between Jardiance and Farxiga that patients should be aware of.
Both medications are approved for heart failure regardless of ejection fraction. However, Jardiance is also FDA-approved to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease, based on data from the EMPA-REG OUTCOME trial.
If your doctor is more concerned with your cardiovascular health, he may choose Jardiance over Farxiga. With that said, both Jardiance and Farxiga are effective medications with a similar side effect profile. When deciding whether Jardiance or Farxiga is a better fit, patient preferences, including cost, should also be taken into account. The most significant factor in whether Jardiance or Farxiga will be cheaper will be your insurance and which one is on the insurance drug formulary. For those paying out of pocket or in cash, Jardiance is slightly more expensive than Farxiga.
Jardiance vs Invokana
Invokana (canagliflozin) is another SGLT2 inhibitor with a similar mechanism of action to Jardiance. Because they are within the same drug class, they work very similarly and provide similar benefits.
Invokana has stronger evidence supporting kidney outcomes in patients with diabetic nephropathy, while Jardiance has more robust data on cardiovascular mortality. These subtle distinctions may guide provider choice depending on the primary condition being treated.
If your doctor is more concerned with your cardiovascular health, he may choose Jardiance over Invokana. With that said, both Jardiance and Invokana are effective medications with a similar side effect profile. Patient preferences, including cost, should also be taken into account when deciding on which medication is best for you. The most significant factor in whether Jardiance or Invokana will be cheaper will be your insurance and which one is on the insurance drug formulary. For those paying out of pocket or in cash, Jardiance is slightly more expensive than Invokana.
Jardiance Dosage and How To Take It
Along with other key heart failure medications, including beta-blockers and diuretics, Jardiance is given as 10 mg once daily. In clinical trials, the blood pressure-lowering effects of the 10 mg dose were not significantly different from those of the 25 mg dose. Given its increased urination effects, it is recommended that Jardiance be taken first thing in the morning, minimizing the possibility of sleep disturbances at night. Jardiance may be taken with or without food.
There is no need to titrate the dose when initiating Jardiance for heart failure, which simplifies therapy. However, patients with renal impairment should be monitored closely to ensure tolerance and response. According to FDA labeling, starting Jardiance is not recommended for patients with an eGFR < 20 mL/min, but continuation may be reasonable under medical supervision.
Common Side Effects and Warnings
Most of Jardiance’s common side effects are a result of increased urine output, which include the following:
- Dehydration
- Urinary Tract Infections (UTIs)
- Yeast infections
- Nasopharyngitis (the common cold)
Serious but rare complications include diabetic ketoacidosis (DKA), acute kidney injury (AKI), and necrotizing fasciitis of the perineum (Fournier’s gangrene). Patients should be educated on recognizing early signs of dehydration, infection, or ketoacidosis symptoms like nausea, vomiting, and abdominal pain.
Older adults (65 years or older), individuals with chronic kidney disease, and those who are volume-depleted are more susceptible to both common and more serious side effects. In any case, patients should regularly follow up with their doctor while taking Jardiance.
Jardiance and Blood Pressure: What To Know
With the mechanism of action associated with Jardiance, including its effects on sodium, researchers have studied its impact on blood pressure. The EMPA-REG BP trial published in 2016 showed that in patients with type diabetes and high blood pressure, patients taking Jardiance had a reduction in blood pressure over 12 weeks. The blood pressure-lowering effect was similar between Jardiance 10 mg and 25 mg. On average, systolic blood pressure dropped by 4-5 mmHg and diastolic by 2-3 mmHg, offering additional cardiovascular protection for patients with hypertension. Importantly, Jardiance’s blood pressure effects are generally mild and do not typically cause hypotension unless the patient is already volume-depleted or on multiple antihypertensives.
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Lifestyle Considerations and Alcohol Use
Patients on Jardiance should avoid excessive alcohol intake, as it can increase the risk of dehydration and ketoacidosis. Maintaining hydration and monitoring blood pressure and blood sugar levels are essential. Individuals should also follow a heart-healthy diet and exercise plan as their provider recommends. A Mediterranean-style diet, rich in fruits, vegetables, whole grains, and healthy fats, is often advised for those with heart failure or diabetes. Smoking cessation, weight management, and limiting sodium intake are key lifestyle interventions.
Final Thoughts: Is Jardiance Right For You?
Jardiance offers a powerful option for managing type 2 diabetes, heart failure, and chronic kidney disease, but it’s not right for everyone. Working closely with your healthcare provider can help you weigh the benefits, such as blood sugar control, heart protection, and kidney support, against potential risks, including dehydration, urinary infections, or rare complications. Before starting Jardiance, your doctor will typically check your kidney function, review your medications, and explain early warning signs to monitor, such as symptoms of infection or ketoacidosis. Staying hydrated and attending regular follow-ups can help ensure the medication remains safe and effective over time.
Ultimately, Jardiance has become a versatile treatment beyond diabetes alone. For many patients, it provides an opportunity to protect multiple organs with a single daily pill. However, therapy should be individualized based on health history, goals, and potential side effects. Having an open conversation with your healthcare provider is crucial in determining whether Jardiance aligns with your long-term care plan.
Frequently Asked Questions
