What is Jardiance Used For?

Jardiance, manufactured by Boehringer Ingelheim, is a prescription medication for the treatment of type 2 diabetes that was approved by the FDA in August 2014. Since then, it has become a commonly prescribed medication for type 2 diabetes. Jardiance contains the active ingredient empagliflozin, which helps manage blood sugar levels by inhibiting the sodium-glucose transporter 2 (SGLT-2) in the kidneys, thereby increasing the elimination of glucose. Although initially developed for the treatment of type 2 diabetes, researchers have discovered additional benefits beyond its glucose-lowering effects, including protection for the heart and kidneys.

A basic understanding of what Jardiance is used for, including its indications and potential side effects, is crucial for achieving sustainable diabetes control. 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?

Jardiance (empagliflozin) is an SGLT2 inhibitor, a class of medications that also includes Invokana (canagliflozin), Farxiga (dapagliflozin), and Steglatro (ertugliflozin). Many of these SGLT2 inhibitors are also available in combination pills with metformin and DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors), including saxagliptin, linagliptin, and sitagliptin. While these drugs share a similar mechanism, their FDA-approved uses and clinical trial results vary. A combination medication, called Synjardy, contains both Jardiance and metformin and is available in both immediate-release and extended-release formulations.

How Jardiance Works

SGLT2 is an abbreviation that stands for sodium-glucose co-transporter 2, a protein located in the kidney that is responsible for the reabsorption of glucose from the kidneys back into the bloodstream. This means that it takes glucose that is being eliminated from the body through the kidneys and puts it back into the bloodstream, thereby increasing the amount of glucose in the blood. As an SGLT2 inhibitor, Jardiance blocks this protein, forcing glucose to be eliminated by the kidneys through urine, which helps lower blood glucose levels.

The SGLT2 protein in the kidney is considered a cotransporter, moving salt in the same direction as glucose, back into the bloodstream from the kidneys. The blocking of this protein by Jardiance also helps eliminate extra salt in the urine, which lowers overall blood volume. This, in turn, helps lower blood pressure as well.

Jardiance Used for Type 2 Diabetes

As an SGLT2 inhibitor, Jardiance helps eliminate glucose through the urine. One benefit of Jardiance compared to other diabetes medications is that it does not depend on insulin and works independently. This insulin-independent mechanism makes Jardiance particularly useful for patients with insulin resistance, a hallmark of type 2 diabetes. By promoting glucose excretion, Jardiance reduces blood sugar levels without overworking the pancreas, which may help preserve beta-cell function over time. In addition to lowering blood sugar, Jardiance offers secondary metabolic benefits. Patients often experience modest weight loss, typically averaging 2 to 3 kilograms (4 to 7 pounds), due to the calorie loss associated with urinary glucose excretion. Jardiance also produces mild diuretic effects, which contribute to a small but meaningful reduction in blood pressure (approximately 3–5 mmHg systolic).

Jardiance is generally used as an add-on to first-line therapy with metformin, but can also be used as monotherapy if metformin is not tolerated or contraindicated. In clinical trials, it has demonstrated durable A1c reductions of approximately 0.7% to 1.0%, with a low risk of hypoglycemia when used alone.

Jardiance’s cardiovascular and kidney benefits make it a desirable option for patients with type 2 diabetes who also have other comorbidities, such as heart failure or chronic kidney disease. Major diabetes guidelines, including the American Diabetes Association (ADA) Standards of Care, recommend considering SGLT2 inhibitors, such as Jardiance, early in treatment for patients with high cardiovascular or renal risk. The standard dose of Jardiance for type 2 diabetes is 10 mg or 25 mg once daily, depending on individual tolerance and therapeutic goals.

Jardiance for 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.

Patients who have congestive heart failure, with or without diabetes, may benefit from Jardiance. It is typically used in combination with other medications, such as beta-blockers (metoprolol, carvedilol), mineralocorticoid receptor antagonists (spironolactone, eplerenone), angiotensin receptor-neprilysin inhibitors (Entresto), and diuretics (furosemide, torsemide), as needed. The standard dose for Jardiance in congestive heart failure is 10 mg once daily.

Jardiance and Chronic Kidney Disease (CKD)

In addition to treating type 2 diabetes and heart failure, Jardiance received FDA approval in September 2023 for the treatment of chronic kidney disease (CKD). This decision was supported by data from the EMPA-KIDNEY trial, which demonstrated promising results in slowing the progression of chronic kidney disease (CKD) and reducing cardiovascular and renal outcomes.

As with type 2 diabetes and congestive heart failure, the benefits are thought to result from Jardiance’s mechanism of action, which involves blocking the SGLT2 protein, leading to the elimination of excess glucose and sodium from the blood. This helps the kidneys function more efficiently by reducing stress on them.

Jardiance is specifically used in patients with chronic kidney disease (CKD) who experience persistent elevated protein in the urine, indicating that the kidneys are overworking. Jardiance is used as an add-on therapy when this happens despite being on an ACE inhibitor (lisinopril) or ARB (losartan), or for patients who cannot tolerate ACE inhibitors or ARBs. The standard dose for Jardiance in chronic kidney disease is 10 mg once daily. Jardiance is now recommended in major clinical guidelines, including KDIGO and ADA Standards of Care, for CKD management.

Other Emerging and Off-Label Uses

In addition to type 2 diabetes, heart failure, and chronic kidney disease, there are ongoing studies evaluating the potential benefit of Jardiance for weight loss, non-alcoholic fatty liver disease (NAFLD), and non-alcoholic steatohepatitis (NASH), the most severe form of NAFLD.

Jardiance is also being studied in patients with polycystic ovary syndrome (PCOS), citing potential improvements in symptoms. Jardiance has shown promise in treating heart failure with preserved ejection fraction (HFpEF), a condition where the heart contracts normally but is stiff and less able to fill.

Although patients taking Jardiance may experience these additional benefits, there has not been enough credible data for the FDA to approve Jardiance for these conditions alone. Until formal approvals are granted, the use of Jardiance for these conditions remains investigational and should be guided by a healthcare provider.

Comparing Jardiance vs Farxiga

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 highly effective, and real-world differences in outcomes are generally minor.

If your doctor is more concerned with your cardiovascular health, he may choose Jardiance over Farxiga. If renal protection is the priority, then Farxiga may be the better option. 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.

Side Effects of Jardiance and What to Watch For

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.

Who Should and Shouldn’t Take Jardiance?

Jardiance is approved for use in adults with type 2 diabetes, chronic kidney disease, and congestive heart failure. For type 2 diabetes only, Jardiance may be used in children 10 years of age or older in combination with diet and exercise.

Depending on what Jardiance is being used to treat, recommendations for patients with impaired kidney function vary:

Jardiance is not recommended during the second and third trimesters of pregnancy or while breastfeeding, due to potential harm to the fetus or newborn. Additionally, Jardiance is not recommended in patients with type 1 diabetes.

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.

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