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When you or someone you love has chronic kidney disease (CKD), understanding the medications can be confusing. You may wonder why this diabetes medication is used for kidney disease, whether it’s safe when taking other prescriptions, and how to know if it’s working.
Empagliflozin, sold under the brand name Jardiance, is a medication that helps protect kidney function in certain adults with CKD, even if they don’t have diabetes. Here’s what you and your loved ones should know about its benefits, possible side effects, and when to contact the healthcare team.
Empagliflozin belongs to a group of medications called sodium-glucose transporter-2 (SGLT2) inhibitors. These medications help the kidneys remove extra sugar and salt through urine. They also help reduce pressure inside the kidneys, which can slow kidney damage over time.
Empagliflozin is also used to treat certain heart conditions. It’s important to know that this medication isn’t just for people with diabetes.
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Empagliflozin can help slow kidney damage and lower the risk of serious complications. However, it can’t reverse damage that has already occurred.
In a large study called EMPA-KIDNEY, researchers followed more than 6,600 people with CKD, including people without diabetes. Those taking empagliflozin were less likely to experience worsening kidney disease or death from heart-related causes than those taking a placebo (an inactive treatment).
When someone starts empagliflozin, their creatinine levels may temporarily rise, and their estimated glomerular filtration rate (eGFR) may drop slightly. Creatinine is a waste product measured in blood tests, while eGFR measures how well the kidneys filter waste from the blood. These changes often happen in the first two to four weeks of treatment.
A small drop in eGFR doesn’t necessarily mean the medication is harming the kidneys. A study showed that after this initial change, eGFR tends to stabilize, and empagliflozin can slow the decline in kidney function over time.
However, larger or unexpected changes should be checked by the healthcare team. Dehydration, illness, and other medications can also affect kidney function.
Yes. Doctors sometimes prescribe empagliflozin along with other medications, such as enalapril or lisinopril. These medications work in different ways to help protect the kidneys and heart.
Taking them together may help slow kidney damage, but the healthcare team will need to monitor kidney function and blood pressure to make sure the treatment is safe.
Empagliflozin isn’t appropriate for everyone with chronic kidney disease. It isn’t recommended for treating CKD in people with polycystic kidney disease or those receiving or recently treated with certain medications that suppress the immune system.
Kidney function, dehydration, and other health conditions can also affect whether the medication is appropriate. Ask your healthcare team if empagliflozin is right for you or your loved one.
For chronic kidney disease, the recommended dose is 10 milligrams once daily in the morning, with or without food.
Before starting treatment, clinicians assess kidney function and check for volume depletion, or having too little fluid in the body. This is especially important for older adults, people with impaired kidney function, and those taking diuretics (water pills).
The care team may continue checking kidney function after treatment begins. Caregivers can help by keeping track of lab appointments and watching for changes such as dizziness, poor appetite, vomiting, diarrhea, or drinking less fluid than usual. Contact the healthcare team right away if these changes occur.
If a dose is missed, it should be taken when remembered unless it’s almost time for the next dose. Don’t take two doses at once to make up for a missed dose.
It’s also helpful to keep an updated medication list. Blood pressure medications, diuretics, insulin, and other diabetes treatments can affect what the care team needs to monitor.
Like any medication, empagliflozin can cause side effects, although not everyone experiences them. You don’t need to monitor every possible reaction, but it helps to recognize important warning signs and know when to contact the healthcare team.
Empagliflozin can cause fluid loss, which may lead to dehydration and low blood pressure. Watch for dizziness, lightheadedness, weakness, fainting, or difficulty drinking enough fluids. This is especially important if you or your loved one experiences vomiting or diarrhea or has trouble eating and drinking normally.
Genital yeast infections can occur with SGLT2 inhibitors. Urinary tract infections, including potentially serious infections, are another concern.
Watch for burning or pain during urination, frequent urination, fever, back or pelvic pain, or blood in the urine. Genital infections may cause itching, discoloration, swelling, discharge, odor, or discomfort.
A rare but serious infection called Fournier’s gangrene can affect tissue around the genitals or anus. Pain, discoloration, tenderness, or swelling in this area, along with fever or feeling very unwell, requires urgent medical attention.
Ketoacidosis is an uncommon but potentially life-threatening condition in which acids called ketones build up in the blood. Warning signs include nausea, vomiting, abdominal pain, fatigue, and trouble breathing. Importantly, blood sugar levels may not be very high.
The risk may increase during prolonged fasting, serious illness, reduced food intake, surgery, or dehydration. Get prompt medical help if symptoms suggest ketoacidosis rather than waiting to see whether they improve.
Empagliflozin alone usually doesn’t cause low blood sugar. The risk increases when it’s combined with insulin or medications that stimulate insulin release. If you or a loved one is taking these medications, ask the healthcare team what symptoms of low blood sugar to watch for and how to treat it.
Empagliflozin may need to be temporarily stopped during illness, dehydration, or prolonged fasting. The prescribing information recommends stopping it at least three days before surgery or procedures that require prolonged fasting, when possible.
Ask your healthcare team for instructions on when to pause and restart the medication, especially if you or your loved one becomes sick or can’t eat or drink normally.
As a caregiver, you can help manage your loved one’s treatment by keeping an updated medication list, tracking appointments and kidney test results, and encouraging them to share concerns with their healthcare team.
Understanding why medications like empagliflozin are prescribed can also help you feel more confident about your loved one’s treatment plan. If something isn’t clear, especially when to pause or restart medication, ask your healthcare team rather than making changes on your own.
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