Indications for JARDIANCE:
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (T2DM). To reduce the risk of cardiovascular (CV) death in adults with T2DM and established CV disease.
Limitations of Use:
Not for treating type 1 diabetes or diabetic ketoacidosis.
Take in the AM. Initially 10mg once daily; may increase to 25mg, if tolerated. Renal impairment: do not initiate if eGFR <45mL/min/1.73m2; discontinue if eGFR falls persistently <45mL/min/1.73m2.
<18yrs: not established.
Severe renal impairment, ESRD, or dialysis.
Correct volume depletion and assess for volume contraction before initiating. Monitor for symptomatic hypotension after starting therapy (esp. elderly, renal impairment or low systolic BP, or on diuretics); more frequently if volume contraction expected. Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue if suspected, evaluate and treat; consider risk factors before initiation (eg, pancreatic insulin deficiency, caloric restriction, alcohol abuse). Evaluate renal function prior to starting and monitor periodically thereafter; more frequently if eGFR <60mL/min/1.73m2. Risk of acute kidney injury in hypovolemia, chronic renal insufficiency, CHF, and concomitant drugs (eg, diuretics, ACEIs, ARBs, NSAIDs). Consider temporarily discontinuing in reduced oral intake or fluid losses; monitor for acute kidney injury; discontinue and treat if occurs. Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Increased risk of genital mycotic infections, UTIs, or elevated LDL-C; monitor and treat as appropriate. Discontinue if hypersensitivity reaction occurs; treat promptly and monitor until resolve. Elderly. Pregnancy (avoid during 2nd & 3rd trimesters). Nursing mothers: not recommended.
Sodium-glucose co-transporter 2 (SGLT2) inhibitor.
Consider a lower dose of concomitant insulin or insulin secretagogue (eg, sulfonylurea) to reduce risk of hypoglycemia. Hypotension with concomitant diuretics. May result in false (+) urine glucose tests or unreliable measurements of 1,5-AG assay; use alternative methods to monitor glycemic control.
UTIs, female genital mycotic infections, increased urination; hypotension, ketoacidosis, renal impairment, urosepsis, pyelonephritis, angioedema; rare: Fournier's gangrene.