Jardiance Side Effects, Warnings, and Drug Interactions

Jardiance (empagliflozin) is a sodium-glucose cotransporter (SGLT2) inhibitor used with diet and exercise to improve glycemia (blood glucose) control in patients with type 2 diabetes.

Common side effects of Jardiance include urinary tract infections (UTIs), female genital fungal infections, upper respiratory tract infection, increased cholesterol, joint pain, nausea, increased creatinine, increased urination, and volume depletion and associated conditions, which include dehydration, fainting, thirst, low blood pressure, and dizziness on standing (orthostatic hypotension).

Serious side effects of Jardiance include low blood pressure (hypotension), kidney failure, ketoacidosis, kidney infections (pyelonephritis), and low blood sugar (hypoglycemia) (when combined with insulin or sulfonylureas).

Drug interactions of Jardiance include diuretics, insulin or drugs that increase insulin secretion, and other SGLT2 inhibitors. Use of Jardiance has not been adequately evaluated in pregnant women. Jardiance is not recommended during the second and third trimesters of pregnancy. It is unknown if Jardiance is excreted in human breast milk. Jardiance is secreted in the milk of lactating rats, and exposure damages the developing kidneys in the rat fetus. Currently, the manufacturer does not recommend use of Jardiance while nursing.

The most common side effects of Jardiance (empagliflozin) are:

• Urinary tract infections
• Female genital fungal infections
• Upper respiratory tract infection
• Increased cholesterol
• Joint pain
• Nausea
• Increased creatinine
• Increased urination

Other possible side effects of Jardiance include:

Volume depletion and associated conditions, which include:

• Dehydration
• Fainting
• Thirst
• Low blood pressure
• Orthostatic hypotension

Serious side effects of Jardiance include:

• Hypotension
• Kidney failure
• Ketoacidosis
• Kidney infections (pyelonephritis)
• Hypoglycemia (when combined with insulin or sulfonylureas)

The following important adverse reactions are described below and elsewhere in the labeling:

• Hypotension
• Ketoacidosis
• Acute Kidney Injury and Impairment in Renal Function
• Urosepsis and Pyelonephritis
• Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues
• Genital Mycotic Infections
• Hypersensitivity Reactions
• Increased Low-Density Lipoprotein Cholesterol (LDL-C)

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Pool Of Placebo-Controlled Trials Evaluating Jardiance 10 And 25 mg

The data in Table 1 are derived from a pool of four 24-week placebo-controlled trials and 18-week data from a placebo-controlled trial with insulin. Jardiance was used as monotherapy in one trial and as add-on therapy in four trials.

These data reflect exposure of 1976 patients to Jardiance with a mean exposure duration of approximately 23 weeks. Patients received placebo (N=995), Jardiance 10 mg (N=999), or Jardiance 25 mg (N=977) once daily. The mean age of the population was 56 years and 3% were older than 75 years of age. More than half (55%) of the population was male; 46% were White, 50% were Asian, and 3% were Black or African American. At baseline, 57% of the population had diabetes more than 5 years and had a mean hemoglobin A1c (HbA1c) of 8%. Established microvascular complications of diabetes at baseline included diabetic nephropathy (7%), retinopathy (8%), or neuropathy (16%). Baseline renal function was normal or mildly impaired in 91% of patients and moderately impaired in 9% of patients (mean eGFR 86.8 mL/min/1.73 m²).

Table 1 shows common adverse reactions (excluding hypoglycemia) associated with the use of Jardiance. The adverse reactions were not present at baseline, occurred more commonly on Jardiance than on placebo and occurred in greater than or equal to 2% of patients treated with Jardiance 10 mg or Jardiance 25 mg.

Table 1: Adverse Reactions Reported in ≥2% of Patients Treated with Jardiance and Greater than Placebo in Pooled Placebo-Controlled Clinical Studies of Jardiance Monotherapy or Combination Therapy

Thirst (including polydipsia) was reported in 0%, 1.7%, and 1.5% for placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively.

Volume Depletion

Jardiance causes an osmotic diuresis, which may lead to intravascular volume contraction and adverse reactions related to volume depletion. In the pool of five placebo-controlled clinical trials, adverse reactions related to volume depletion (e.g., blood pressure (ambulatory) decreased, blood pressure systolic decreased, dehydration, hypotension, hypovolemia, orthostatic hypotension, and syncope) were reported by 0.3%, 0.5%, and 0.3% of patients treated with placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively. Jardiance may increase the risk of hypotension in patients at risk for volume contraction.

Increased Urination

In the pool of five placebo-controlled clinical trials, adverse reactions of increased urination (e.g., polyuria, pollakiuria, and nocturia) occurred more frequently on Jardiance than on placebo (see Table 1). Specifically, nocturia was reported by 0.4%, 0.3%, and 0.8% of patients treated with placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively.

Acute Impairment in Renal Function

Treatment with Jardiance was associated with increases in serum creatinine and decreases in eGFR (see Table 2). Patients with moderate renal impairment at baseline had larger mean changes.

In a long-term cardiovascular outcome trial, the acute impairment in renal function was observed to reverse after treatment discontinuation suggesting acute hemodynamic changes play a role in the renal function changes observed with empagliflozin.

Table 2: Changes from Baseline in Serum Creatinine and eGFRa in the Pool of Four 24-week Placebo-Controlled Studies and Renal Impairment Study

Hypoglycemia

The incidence of hypoglycemia by study is shown in Table 3. The incidence of hypoglycemia increased when Jardiance was administered with insulin or sulfonylurea.

Table 3 Incidence of Overall^a and Severe^b Hypoglycemic Events in Placebo-Controlled Clinical Studies^c

Genital Mycotic Infections

In the pool of five placebo-controlled clinical trials, the incidence of genital mycotic infections (e.g., vaginal mycotic infection, vaginal infection, genital infection fungal, vulvovaginal candidiasis, and vulvitis) was increased in patients treated with Jardiance compared to placebo, occurring in 0.9%, 4.1%, and 3.7% of patients randomized to placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively. Discontinuation from study due to genital infection occurred in 0% of placebo-treated patients and 0.2% of patients treated with either Jardiance 10 or 25 mg.

Genital mycotic infections occurred more frequently in female than male patients (see Table 1).

Phimosis occurred more frequently in male patients treated with Jardiance 10 mg (less than 0.1%) and Jardiance 25 mg (0.1%) than placebo (0%).

Urinary Tract Infections

In the pool of five placebo-controlled clinical trials, the incidence of urinary tract infections (e.g., urinary tract infection, asymptomatic bacteriuria, and cystitis) was increased in patients treated with Jardiance compared to placebo (see Table 1). Patients with a history of chronic or recurrent urinary tract infections were more likely to experience a urinary tract infection. The rate of treatment discontinuation due to urinary tract infections was 0.1%, 0.2%, and 0.1% for placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively.

Urinary tract infections occurred more frequently in female patients. The incidence of urinary tract infections in female patients randomized to placebo, Jardiance 10 mg, and Jardiance 25 mg was 16.6%, 18.4%, and 17.0%, respectively. The incidence of urinary tract infections in male patients randomized to placebo, Jardiance 10 mg, and Jardiance 25 mg was 3.2%, 3.6%, and 4.1%, respectively.

Laboratory Tests

Increase in Low-Density Lipoprotein Cholesterol (LDL-C)

Dose-related increases in low-density lipoprotein cholesterol (LDL-C) were observed in patients treated with Jardiance. LDL-C increased by 2.3%, 4.6%, and 6.5% in patients treated with placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively. The range of mean baseline LDL-C levels was 90.3 to 90.6 mg/dL across treatment groups.

Increase in Hematocrit

In a pool of four placebo-controlled studies, median hematocrit decreased by 1.3% in placebo and increased by 2.8% in Jardiance 10 mg and 2.8% in Jardiance 25 mg treated patients. At the end of treatment, 0.6%, 2.7%, and 3.5% of patients with hematocrits initially within the reference range had values above the upper limit of the reference range with placebo, Jardiance 10 mg, and Jardiance 25 mg, respectively.

Postmarketing Experience

Additional adverse reactions have been identified during postapproval use of Jardiance. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

• Ketoacidosis
• Urosepsis and pyelonephritis
• Angioedema
• Skin reactions (e.g., rash, urticaria)

Diuretics

Coadministration of empagliflozin with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.

Insulin Or Insulin Secretagogues

Coadministration of empagliflozin with insulin or insulin secretagogues increases the risk for hypoglycemia.

Positive Urine Glucose Test

Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors as SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests. Use alternative methods to monitor glycemic control.

Interference With 1,5-Anhydroglucitol (1,5-AG) Assay

Monitoring glycemic control with 1,5-AG assay is not recommended as measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.