What Is Jardiance (Empagliflozin)?
Jardiance is the brand name for empagliflozin, a prescription medication developed by Boehringer Ingelheim and Eli Lilly. It belongs to the SGLT2 inhibitor class — a family of drugs that lower blood sugar in a fundamentally different way than older diabetes medications. Beyond glucose control, Jardiance has demonstrated meaningful cardiovascular and kidney-protective benefits, earning multiple FDA approvals that extend well beyond type 2 diabetes management.
How Jardiance Works: The Kidney as a Sugar Filter
Under normal physiology, the kidneys filter glucose out of the blood but then reabsorb almost all of it back into the body through transporter proteins — specifically SGLT2 (sodium-glucose cotransporter 2), which handles roughly 90% of glucose reabsorption in the proximal tubule of the kidney. Empagliflozin blocks this transporter, preventing reabsorption and allowing excess glucose to be excreted in the urine.
This mechanism is notable for several reasons. First, it is entirely insulin-independent — it works regardless of how much insulin the pancreas can produce. Second, because it only acts when blood glucose is elevated enough to be filtered in significant amounts, the risk of severe hypoglycemia is low compared to insulin or sulfonylureas. Third, the caloric loss from excreting glucose in the urine (~70 grams/day at therapeutic effect) contributes to modest weight reduction.
FDA-Approved Indications
| Indication | Approval Year | Key Evidence |
|---|---|---|
| Type 2 diabetes (glycemic control) | 2014 | Phase 3 EMPA-REG OUTCOME |
| CV death reduction in T2D + established CVD | 2016 | EMPA-REG OUTCOME trial |
| Heart failure with reduced ejection fraction (HFrEF) | 2021 | EMPEROR-Reduced trial |
| Heart failure with preserved ejection fraction (HFpEF) | 2022 | EMPEROR-Preserved trial |
| Chronic kidney disease (CKD) to reduce progression | 2023 | EMPA-KIDNEY trial |
The EMPA-REG OUTCOME Trial: A Landmark in Cardiology
EMPA-REG OUTCOME enrolled 7,020 adults with type 2 diabetes and established cardiovascular disease. After a median follow-up of 3.1 years, empagliflozin reduced the composite of cardiovascular death, non-fatal heart attack, and non-fatal stroke by 14% compared to placebo. Cardiovascular death alone was reduced by 38%, and hospitalization for heart failure was cut by 35%. These were striking results — particularly the heart failure findings, which emerged faster than the atherosclerotic outcomes and suggested a mechanism beyond mere glucose lowering.
The heart failure benefit is now understood to be driven in part by SGLT2 inhibitors' osmotic diuresis effect (they cause the kidneys to excrete more sodium and water, reducing fluid overload), as well as possible direct effects on cardiac metabolism and ventricular remodeling. This is why Jardiance's heart failure approval was eventually extended to patients without diabetes — the benefit appears to be class-wide and not tied to glycemic effects.
Side Effects of Jardiance
Genital mycotic infections
Because empagliflozin increases glucose in the urine, it creates a favorable environment for yeast growth in the genital area. Genital yeast infections (vulvovaginal candidiasis in women, balanitis in men) are among the most common side effects, affecting a meaningful percentage of patients. Most are mild to moderate and respond to standard antifungal treatment.
Urinary tract infections
Glycosuria also raises the risk of urinary tract infections. Patients should maintain good hydration and report symptoms promptly. Those with recurrent UTIs may need additional assessment before or during treatment.
DIABETIC KETOACIDOSIS (DKA): SGLT2 inhibitors have been associated with euglycemic DKA — a form of DKA that can occur even when blood glucose is near-normal, making it harder to recognize. This is particularly relevant around surgical procedures, fasting states, or serious illness. Jardiance should be held before elective surgery (typically 3–4 days) per current guidelines. Symptoms: nausea, vomiting, abdominal pain, fatigue, difficulty breathing. This requires emergency evaluation.
FOURNIER'S GANGRENE: Rare but serious necrotizing fasciitis of the genitalia and perineum has been reported with SGLT2 inhibitors. Seek immediate medical attention for pain, tenderness, erythema, or swelling in the genital or perineal area with fever.
Volume depletion and hypotension
The diuretic effect of empagliflozin can cause dehydration and low blood pressure, particularly in older patients or those on diuretics. Symptoms include dizziness on standing, lightheadedness, and weakness.
Lower limb amputation risk
The CANVAS trial of canagliflozin (a related SGLT2 inhibitor) found a doubled risk of lower limb amputation. This signal was not replicated consistently in EMPA-REG or subsequent Jardiance studies, but patients with peripheral arterial disease or active foot problems should be monitored carefully.
Comparing SGLT2 Inhibitors
| Drug | Brand | Key Approval Beyond T2D |
|---|---|---|
| Empagliflozin | Jardiance | HFrEF, HFpEF, CKD, CV death in T2D |
| Dapagliflozin | Farxiga | HFrEF, HFpEF, CKD (DAPA-HF, DAPA-CKD) |
| Canagliflozin | Invokana | CKD progression, CV events in T2D (CREDENCE) |
All three agents share the same core mechanism, but they differ in their specific clinical trial evidence, FDA-approved indications, and dosing considerations. Empagliflozin and dapagliflozin currently have the broadest non-diabetes approvals. The choice among them is often guided by individual patient comorbidities, insurance formulary placement, and clinical trial evidence most relevant to that patient's conditions.
Who Should Avoid Jardiance
Jardiance is contraindicated in patients with type 1 diabetes (significantly elevated DKA risk), severe renal impairment or end-stage kidney disease (reduced efficacy and potential harm), and known hypersensitivity to empagliflozin. It is not recommended during pregnancy or breastfeeding. Patients with recurrent genital infections, history of lower limb amputations, or active bladder problems may warrant extra discussion with their provider before starting.
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Compare MedicationsFrequently Asked Questions
No. Jardiance is not an anticoagulant or blood thinner. It does not affect clotting factors or platelet function. Its cardiovascular benefits are mediated through different mechanisms — reduction in fluid overload, improvements in cardiac metabolism, and effects on blood pressure and uric acid, among others.
Yes, modest weight loss is a common effect of Jardiance. By causing the kidneys to excrete glucose in the urine rather than reabsorbing it, the body loses a meaningful number of calories each day. Clinical trials have demonstrated average weight reductions in the range of 2–3 kg. This is a secondary benefit rather than the primary indication, and is considerably less dramatic than the weight loss seen with GLP-1 receptor agonists like semaglutide.
For most patients with type 2 diabetes, heart failure, or established chronic kidney disease, Jardiance has been shown in clinical trials to slow the progression of kidney disease. The EMPA-KIDNEY trial demonstrated significant reduction in kidney disease progression and cardiovascular death. However, the drug is not effective and may be harmful in patients with severely reduced kidney function (very low eGFR) — those patients require different management strategies.