Snapshot

Active ingredient
Empagliflozin (SGLT2 inhibitor)
Relevant conditions
Type 2 diabetes, cardiovascular disease, heart failure
Available strengths
10 mg and 25 mg oral tablets

Empagliflozin is best known by the brand name Jardiance in the United States. It works by increasing glucose loss in the urine and has proven cardiovascular and heart failure benefits in appropriate patients. For legal access information, jump to Legal status and access in the USA.

What empagliflozin is used for

Primary indications

  • Lowering blood sugar in adults and children 10 years and older with type 2 diabetes, when used with diet and exercise.
  • Reducing the risk of cardiovascular death in adults with type 2 diabetes and established heart disease.
  • Reducing the risk of cardiovascular death and hospitalization for heart failure in adults with symptomatic heart failure (when the heart does not pump properly), with or without diabetes.

Not indicated for: treatment of type 1 diabetes or diabetic ketoacidosis.

For dose guidance, see How to take and typical dosing. For alternatives with similar benefits, head to Alternatives and similar medicines.

How to take and typical dosing

Follow your prescriber's exact instructions and the pharmacy label. General guidance:

  • Take once daily, preferably in the morning, with or without food.
  • Common starting dose: 10 mg once daily. If tolerated and additional glucose lowering is needed, the dose may be increased to 25 mg once daily.
  • Your clinician may monitor kidney function and adjust use accordingly. For certain kidney or heart failure indications, use may be appropriate even with reduced kidney function, but for glucose control alone it may not be effective at very low eGFR.
  • Monitor blood glucose regularly. Your clinician may ask you to check urine or blood ketones during illness, low carbohydrate intake, or rapid insulin dose changes.

If you are pregnant or planning to become pregnant, discuss a plan early. See Warnings and precautions.

Warnings and precautions

Tell your clinician before starting empagliflozin if you have any of the following:

  • History of genital infections or urinary tract infections, problems urinating, or frequent yeast infections.
  • Kidney or liver disease; dehydration; low blood pressure; use of diuretics; low salt intake; or if you are 65 years or older.
  • Pancreatic disorders or surgery; heavy alcohol use; ketogenic or very low carbohydrate diets.
  • Pregnancy or plans to become pregnant; breastfeeding.

Important safety notes:

  • Empagliflozin may cause ketoacidosis (even if glucose is not very high). Seek help urgently if nausea, vomiting, stomach pain, unusual fatigue, or trouble breathing occur.
  • Volume depletion and low blood pressure can occur. Rise slowly from sitting or lying positions to reduce dizziness or fainting.
  • Genital mycotic infections and urinary tract infections are more common. Maintain good hygiene and report symptoms early.
  • Avoid excessive alcohol, which raises risks of dehydration and ketoacidosis.
  • Pregnancy: generally avoid in the 2nd and 3rd trimesters due to fetal renal risk. Breastfeeding is not recommended because of potential adverse effects on the infant’s kidneys.

Who should not use empagliflozin

  • Anyone with a known allergy to empagliflozin or any tablet component.
  • People with severe kidney disease or on dialysis.
  • Pregnant individuals in the 2nd or 3rd trimester. Breastfeeding is generally not recommended.

For legal dispensing rules, see Legal status and access in the USA.

Possible side effects

Get emergency help for signs of a severe allergic reaction: hives, trouble breathing, or swelling of the face, lips, tongue, or throat.

Seek urgent care if any of the following occur:

  • Severe genital symptoms (penis or vagina): burning, itching, odor, discharge, pain or tenderness, redness or swelling, fever, or feeling unwell.
  • Severe dizziness or fainting; signs of dehydration such as intense thirst, confusion, or markedly reduced urination.
  • Symptoms of ketoacidosis: nausea, vomiting, stomach pain, confusion, unusual sleepiness, or difficult breathing.
  • Signs of a bladder infection: painful urination, blood in urine, pelvic or back pain, or fever.
  • Low blood sugar (often when used with insulin or sulfonylureas): headache, hunger, sweating, shakiness, fast heartbeat, confusion, or irritability.

More common, usually mild:

  • Genital yeast infections, especially in women.
  • Urinary tract infections.
  • Increased urination or thirst.

Report persistent or severe effects to your prescriber. See also Drug interactions that might raise risks.

Drug interactions

Always share a complete medication list with your clinician and pharmacist, including over-the-counter products and supplements. Notable interactions include:

  • Insulin or insulin secretagogues (such as sulfonylureas): higher risk of hypoglycemia; dose adjustments may be needed.
  • Diuretics or water pills: increased risk of dehydration and low blood pressure.
  • Other blood pressure medicines: additive blood pressure lowering may occur.
  • Alcohol or ketogenic diets: increased risk of ketoacidosis.

Empagliflozin has minimal CYP-based interactions, but clinical effects with the above agents can be significant. For advice on access rules, see Legal status in the USA.

Missed dose or overdose

Missed dose: Take it when you remember unless it is close to the next dose. If so, skip the missed dose. Do not take two doses at the same time.

Overdose: Seek emergency care. In the USA, contact Poison Control at 1-800-222-1222 or via poisonhelp.org.

Alternatives and similar medicines

Medicines with similar mechanisms or benefits may be considered if empagliflozin is not suitable or not available. Selection depends on your health profile, kidney function, A1C targets, weight goals, and cardiovascular status.

Other SGLT2 inhibitors (similar class):

  • Dapagliflozin (Farxiga) - also has heart failure and kidney benefits.
  • Ertugliflozin (Steglatro) - similar glucose effects; cardiovascular data differ.
  • Canagliflozin (Invokana) - proven kidney and cardiovascular benefits; different safety profile.

Combination tablets including empagliflozin:

  • Synjardy - empagliflozin plus metformin.
  • Glyxambi - empagliflozin plus linagliptin (a DPP-4 inhibitor).

Other classes used for type 2 diabetes:

  • GLP-1 receptor agonists: semaglutide (Ozempic, Rybelsus), dulaglutide (Trulicity), liraglutide (Victoza) - strong A1C reduction and weight loss; several have cardiovascular benefit.
  • DPP-4 inhibitors: sitagliptin, linagliptin, alogliptin - weight neutral; modest A1C reduction.
  • Metformin - first-line for many; inexpensive and weight neutral or modest loss.
  • Sulfonylureas: glipizide, glimepiride - low cost; risk of hypoglycemia and weight gain.
  • Thiazolidinediones: pioglitazone - effective; consider edema and heart failure risk.

Discuss options with your clinician to match therapy to your goals. For how prices compare in the USA, see Price overview in USD.

Price overview in USD (typical monthly cash prices)

Approximate out-of-pocket prices vary by pharmacy, discounts, and insurance. Ranges below are rough estimates for a 30-day supply in the USA as of recent public data; your cost may differ substantially.

  • Empagliflozin (Jardiance) 10 mg or 25 mg: about $560-$650.
  • Dapagliflozin (Farxiga): roughly $560-$650.
  • Canagliflozin (Invokana): often $500-$620.
  • Ertugliflozin (Steglatro): commonly $400-$520.
  • Synjardy (empagliflozin + metformin): approximately $650-$750.
  • Metformin generic: many pharmacies offer $4-$15.
  • GLP-1 RAs (e.g., semaglutide): frequently $900-$1200.
  • DPP-4 inhibitors: brand products may be several hundred dollars; generics (e.g., sitagliptin) can be markedly less depending on pharmacy.

Use reputable discount programs or insurance formularies to reduce cost. For lawful ways to buy, see Legal status and access in the USA.

Storage and handling

  • Store at room temperature, typically 68-77 F (20-25 C); short excursions are usually permitted per label.
  • Protect from excess moisture and heat. Keep in the original container until use.
  • Keep out of reach of children and pets. Dispose of unused tablets according to local guidance; a take-back program is preferred.

If you have questions about storage conditions, ask your pharmacist.