Jardiance
Jardiance
Generic Name
Jardiance
Mechanism
Empagliflozin selectively blocks SGLT‑2 transporters in the proximal renal tubules, reducing glucose reabsorption by ~60 %. This leads to:
• Glucosuria and a 30–40 mg/dL decline in post‑prandial glucose.
• Caloric loss (~200 kcal/day) → modest weight reduction.
• Osmotic diuresis → modest blood‑pressure lowering.
Because it is glucose‑dependent, fasting blood glucose is largely preserved, minimizing *hypoglycaemic* risk when used as monotherapy or with agents lacking this property.
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Pharmacokinetics
| Parameter | Value | Notes |
| Absorption | Oral; bioavailability ~75 % | Wound in 2 h post‑dose. |
| Distribution | Cmax ≈ 15 µg/mL; protein binding 85 % | Linear kinetics across 10–50 mg. |
| Metabolism | Phase II glucuronidation (UGT1A9), minimal CYP450 involvement | Avoid strong CYP1A2 inhibitors. |
| Elimination | 50 % renal; 8 % fecal | Half‑life 10–13 h; steady‑state within 3 days. |
| Renal Dose Adjustments | 10 mg q.d. if CrCl 30–60 mL/min; 5 mg q.d. if <30 | No dosing in ESRD (dialysis). |
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Indications
- Type 2 diabetes mellitus – as monotherapy, add‑on to diet and exercise, or add‑on to insulin.
- Heart failure with reduced ejection fraction – reduces cardiovascular death.
- Chronic kidney disease – slows eGFR decline (in patients with ACR > 300 mg/g).
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Contraindications
- Contraindicated: Severe renal impairment (CrCl < 30 mL/min), end‑stage renal disease, severe dehydration.
- Warnings:
- *Genitourinary infections* (candidiasis, UTI).
- *Diabetic ketoacidosis (DKA)* – especially in insulin‑treated patients or low-carb diets.
- *Euglycaemic DKA*: monitor ketones.
- *Volume depletion* → hypotension.
- *Hypotension*, *falls* risk in elderly or post‑dialysis.
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Dosing
| Regimen | Typical Start | Titration | Comments |
| Type 2 DM | 10 mg q.d. | Can increase to 25 mg q.d. after 1–2 weeks | *Educate* on glycaemic monitoring. |
| HF‑REF / CKD | 10 mg q.d. | 25 mg q.d. if tolerated | Keep eGFR >30 mL/min/1.73 m². |
• Take with or without food; avoid alcohol.
• Patients on diuretics: monitor electrolytes & BP.
• OTC: avoid in pregnancy (category B, not well‑studied).
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Adverse Effects
Common (≤ 10 %)
• Genital mycotic infections
• Urinary tract infections
• Polyuria, nocturia
• Dizziness/Hypotension
Serious (> 1 %)
• Diabetic ketoacidosis (rare but serious)
• Fournier’s gangrene (case reports; advise reporting)
• Acute kidney injury (esp. with volume depletion)
• Fractures (in some trials)
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Monitoring
- Baseline: eGFR, ACR, fasting glucose, ketones (if high-risk).
- Follow‑up:
- eGFR every 3–6 months in CKD.
- HbA1c every 3–6 months.
- BP, weight for metabolic effects.
- Ketones if new symptoms (polyuria, nausea, abdominal pain).
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Clinical Pearls
- SGLT‑2 inhibitors counteract insulin‑induced hypoglycaemia: perfect for patients with sulfonylureas or insulin when tight glycaemic control is needed.
- Weight loss + BP reduction often seen even before glycaemic benefit—useful in metabolic syndrome.
- DKA risk: educate patients on “sick day rules”; consider dose reduction or temporary hold if severe illness or low carb intake.
- Renal protection: evidence from EMPA‑REG OUTCOME indicates slower eGFR decline—think of Jardiance as dual therapy for diabetes + CKD.
- Travel & dehydration: advise increasing fluid intake or temporary drug pause if traveling to low‑humidity zones.
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• *All information reflects current FDA labeling (2024) and peer‑reviewed studies. For individualized patient care, consult the latest clinical guidelines and pharmacopoeia.*