empagliflozin (Jardiance)

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Indications

Contraindications

* among patients with eGFR of 20-45 mL/min, empaglifozin 10 mg QD decreased risk of progression of kidney disease or death from cardiovascular causes[17]

Dosage

  • stop 3 days prior to surgery

* in patients with HFpEF, need for diuretics generally less in patients also using empagliflozin[20]

Adverse effects

Drug interactions

Mechanism of action

Notes

  • efficacy of empagliflozin in reducing HbA1c in clinical trials translates into real-world effectiveness[7]
  • empagliflozin more effective than dapagliflozin in reducing hospitalization or all-cause mortality[26] or compared with patients who started dapagliflozin

More general terms

Component of

References

  1. Medscape: August 1, 2014 Diabetes Drug Empagliflozin (Jardiance) Wins FDA OK on Second Try. http://www.medscape.com/viewarticle/829326
  2. 2.0 2.1 FDA MedWatch. May 15, 2015 SGLT2 inhibitors: Drug Safety Communication - FDA Warns Medicines May Result in a Serious Condition of Too Much Acid in the Blood. https://mail.google.com/mail/u/0/?tab=wm#inbox/14d587f1089e0791
  3. 3.0 3.1 3.2 Lily News Release. Aug. 20, 2015 Jardiance<TM> demonstrated cardiovascular (CV) risk reduction in people with type 2 diabetes at high risk for CV events. https://investor.lilly.com/releasedetail.cfm?ReleaseID=928280
  4. 4.0 4.1 4.2 4.3 Zinman B et al Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. Sept 17, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26378978 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1504720
  5. 5.0 5.1 5.2 Wanner C et al Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. June 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27299675 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1515920
    Ingelfinger JR, Rosen CJ Cardiac and Renovascular Complications in Type 2 Diabetes - Is There Hope? N Engl J Med. June 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26605932 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1607413
  6. 6.0 6.1 Gever J Jardiance Wins CV Prevention Indication. FDA approves claim that diabetes drug reduces cardiovascular death risk. Medpage Today. December 02, 2016 http://www.medpagetoday.com/Cardiology/Prevention/61822
    Tucker ME FDA Approves Empagliflozin for Reducing CVD Death. Medscape. Dec 02, 2016. http://www.medscape.com/viewarticle/872697
    FDA News Release. Dec 2, 2016 FDA approves Jardiance to reduce cardiovascular death in adults with type 2 diabetes. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm531517.htm
  7. 7.0 7.1 Munk NE, Knudsen JS, Pottegard A, Witte DR, Thomsen RW. Differences Between Randomized Clinical Trial Participants and Real-World Empagliflozin Users and the Changes in Their Glycated Hemoglobin Levels. JAMA Netw Open. 2020;3(2):e1920949. Feb 7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32031651 Free Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760444
  8. 8.0 8.1 Phend C Second SGLT2 Drug Scores for HFrEF, Regardless of Diabetes Status.
    EMPEROR-Reduced trial "exceptionally concordant" with DAPA-HF results. MedPage Today August 28, 2020 https://www.medpagetoday.com/meetingcoverage/esc/88346
    Packer M, Anker S, Butler J et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020 Aug 29; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32865377 https://www.nejm.org/doi/10.1056/NEJMoa2022190
  9. 9.0 9.1 Santos-Gallego CG et al. Randomized trial of empagliflozin in nondiabetic patients with heart failure and reduced ejection fraction. J Am Coll Cardiol 2021 Jan 26; 77:243 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33197559. https://www.sciencedirect.com/science/article/abs/pii/S0735109720377536
    Goldberg LR. The pleiotropic effects of SGLT2 inhibitors: Remodeling the treatment of heart failure. J Am Coll Cardiol 2021 Jan 26; 77:256. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33478648 https://www.sciencedirect.com/science/article/abs/pii/S0735109720378931
  10. 10.0 10.1 Packer M et al. Empagliflozin in patients with heart failure, reduced ejection fraction, and volume overload: EMPEROR-Reduced trial. J Am Coll Cardiol 2021 Mar 23; 77:1381. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33736819 https://www.sciencedirect.com/science/article/pii/S0735109721002023
    Kosiborod M, Vaduganathan M. SGLT-2 inhibitors in heart failure: Volume or value? J Am Coll Cardiol 2021 Mar 23; 77:1393. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33736820 https://www.sciencedirect.com/science/article/abs/pii/S0735109721003090
  11. 11.0 11.1 Ferreira JP et al. Interplay of mineralocorticoid receptor antagonists and empagliflozin in heart failure: EMPEROR-Reduced. J Am Coll Cardiol 2021 Mar 23; 77:1397 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33736821 Free article https://www.sciencedirect.com/science/article/pii/S0735109721002394
  12. 12.0 12.1 Anker SD, Butler J, Filippatos G et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021. Oct 14;385(16):1451-1461. Aug 27; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34449189 https://www.nejm.org/doi/10.1056/NEJMoa2107038
  13. 13.0 13.1 Butler J, Filippatos G, Siddiqi TJ et al Empagliflozin, health status, and quality of life in patients with heart failure and preserved ejection fraction: The EMPEROR-Preserved Trial. Circulation 2021 Nov 15; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34779658 Free article https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057812
  14. 14.0 14.1 Verma S, Dhingra NK, Butler J et al. Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): A post-hoc analysis of a randomised, double-blind trial. Lancet Diabetes Endocrinol 2022 Jan; 10:35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34861154 https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00292-8/fulltext
    Ryden L, Ferrannini G. Is the impact of add on heart failure therapy influenced by background therapy? Lancet Diabetes Endocrinol 2022 Jan; 10:3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34861151 https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00311-9/fulltext
  15. 15.0 15.1 Kosiborod MN et al. Effects of empagliflozin on symptoms, physical limitations and quality of life in patients hospitalized for acute heart failure - Results from the EMPULSE trial. Circulation 2022 Apr 4; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35377706 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059725
  16. 16.0 16.1 16.2 Schulze PC et al. Effects of early empagliflozin initiation on diuresis and kidney function in patients with acute decompensated heart failure (EMPAG-HF). Circulation 2022 Jun 29; PMID: https://www.ncbi.nlm.nih.gov/pubmed/35766022 Free article https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059038
  17. 17.0 17.1 The EMPA-KIDNEY Collaborative Group Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2022. Nov 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36331190 https://www.nejm.org/doi/full/10.1056/NEJMoa2204233
  18. 18.0 18.1 Zheng J, Parizo JT, Spertus JA et al Cost-effectiveness of Empagliflozin in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Intern Med. Published online November 7, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36342696 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2797773
  19. 19.0 19.1 Ferreira JP, Zannad F, MD, Butler J et al Association of Empagliflozin Treatment With Albuminuria Levels in Patients With Heart Failure. A Secondary Analysis of EMPEROR-Pooled. JAMA Cardiol. 2022;7(11):1148-1159 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36129693 PMCID: PMC9494272 Free PMC article https://jamanetwork.com/journals/jamacardiology/fullarticle/2796744
  20. 20.0 20.1 Butler J, Shariq Usman M, Filippatos G et al Safety and Efficacy of Empagliflozin and Diuretic Use in Patients with Heart Failure and Preserved Ejection Fraction. A Post Hoc Analysis of the EMPEROR- Preserved Trial. JAMA Cardiol. Published online May 24, 2023. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37223933 https://jamanetwork.com/journals/jamacardiology/fullarticle/2805335
  21. 21.0 21.1 Engelhardt K, Ferguson M, Rosselli JL. Prevention and Management of Genital Mycotic Infections in the Setting of Sodium-Glucose Cotransporter 2 Inhibitors. Ann Pharmacother. 2021 Apr;55(4):543-548. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32808541 Review.
  22. 22.0 22.1 22.2 NEJM Knowledge+ Endocrinology
  23. 23.0 23.1 Bersoff-Matcha SJ, Chamberlain C, Cao C et al Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019. May 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31060053 https://annals.org/aim/article-abstract/2732837/fournier-gangrene-associated-sodium-glucose-cotransporter-2-inhibitors-review-spontaneous
  24. 24.0 24.1 EMPA-KIDNEY Collaborative Group Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol. 2024 Jan;12(1):51-60 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38061372 Free article https://www.thelancet.com/journals/landia/article/PIIS2213-8587(23)00322-4/fulltext
  25. 25.0 25.1 Alexander JT, Singh SK, Shah SD, Lambert B, Smith JP. 2023 Update in ambulatory general internal medicine Cleveland Clinic Journal of Medicine January 2024, 91 (1) 40-46 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38167397 Free article. Review. https://www.ccjm.org/content/91/1/40
  26. 26.0 26.1 Modzelewski KL, Pipilas A, Bosch NA Comparative Outcomes of Empagliflozin to Dapagliflozin in Patients With Heart Failure. JAMA Netw Open. 2024;7(5):e249305 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38696170 PMCID: PMC11066699 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818219
  27. Highlights of Prescribing Information JARDIANCE (empagliflozin tablets), for oral use https://docs.boehringer-ingelheim.com/Prescribing%20Information/PIs/Jardiance/jardiance.pdf

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