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Key takeaways
Jardiance should be discontinued three days before surgery.
Taking Jardiance on the day of an operation raises the risk of ketoacidosis and a dangerous drop in blood pressure.
Most people can restart Jardiance when back to eating normally after surgery, but it’s essential to follow the personalized medical guidance from your surgical care or diabetes care team.
Jardiance (empagliflozin) is a prescription medication that helps lower blood sugar in people with Type 2 diabetes mellitus. It is also approved by the Food and Drug Administration (FDA) to reduce the risk of cardiovascular death in adults diagnosed with heart failure or both heart disease and Type 2 diabetes, and to lower the risk of decline in kidney function and cardiovascular death or hospitalization in certain adults with chronic kidney disease (CKD). When taken as directed, Jardiance is a safe and effective medication, but it is one of several medications that can cause extra risks during surgery.
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Why Jardiance may be a concern before surgery
Jardiance belongs to a class of drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors. SGLT2 inhibitors primarily help flush out excess blood glucose through the urine, but they also have some indirect effects, like lowering blood pressure. And it’s this combination of facts that makes Jardiance a concern before surgery.
The main reason for stopping Jardiance before surgery is that the stress of surgery can cause blood sugar instability that leads to diabetic ketoacidosis, according to Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. But he also lists another reason for discontinuing this drug a few days before surgery: Jardiance’s effects on blood pressure.
Risk of euglycemic diabetic ketoacidosis (EDKA)
Many people with diabetes already know diabetic ketoacidosis (DKA) as a serious complication that can lead to loss of consciousness, coma, and even death. Although typically associated with Type 1 diabetes mellitus, DKA can occur in Type 2 diabetes, more so when taken with SGLT2 inhibitors. In most cases, hyperglycemia (high glucose levels) is a warning sign of DKA. But with euglycemic ketoacidosis, blood sugar levels may look normal, potentially delaying treatment.
Here’s why use of SGLT2 inhibitors causes an increased risk of this adverse event: The stress of surgery, change in dietary intake, and possible reduction in insulin dose around the time of surgery already disrupts blood sugar regulation. Adding an SGLT2 inhibitor to the mix can mask warning signs of DKA. “Blood sugar levels may look normal or only mildly elevated, instead of very high,” says Kaitlin Hippley, a registered dietitian and certified diabetes educator in Cleveland, Ohio. “However, the body still has an insulin deficiency, which causes it to break down fat for energy and produce ketones. These ketones then build up and make the blood dangerously acidic.” If not treated promptly, euglycemic DKA can be life-threatening.
Low blood pressure
Jardiance can also cause an unsafe drop in blood pressure during surgery, according to Dr. Ali. Blood pressure regulation is important during surgery since abnormal blood pressure has been linked to unfavorable surgical outcomes. For instance, the American Society of Anesthesiologists has found that low blood pressure during surgery can increase the risk of postoperative delirium. As listed on the drug’s label, Jardiance can contribute to volume depletion or dehydration, which may explain the risk of low blood pressure during surgery.
Jardiance before surgery: Official guidelines
The prescribing information for Jardiance instructs healthcare providers to advise patients to discontinue Jardiance for at least three days before any scheduled surgery or procedure that requires prolonged fasting. In general, Jardiance should simply be stopped, not gradually weaned, three days before surgery. That said, it’s important to follow the personalized medical guidance of your diabetes care team and surgical team.
Jardiance alternatives before surgery
First things first: Never stop, start, or switch prescription diabetes or heart failure medications without the guidance of your healthcare provider. It’s important to work with your surgical team or diabetes care team when considering a Jardiance alternative in the days or weeks before surgery.
Other medications that are not recommended before surgery include other SGL2 inhibitors like Invokana (canagliflozin), Farxiga (dapagliflozin), and Steglatro (ertugliflozin.) Glucagon-like peptide-1 (GLP1) receptor agonists, like Ozempic (semaglutide), Rybelsus (semaglutide), Mounjaro (tirzepatide), and Trulicity (dulaglutide), are stopped in advance of surgery too.
Heart failure alternatives
A 2022 review of cardiovascular medications concluded that several drug types are typically safe to take before major surgery, including the following:
- Beta blockers like Atenolol, bisoprolol, and metoprolol
- Calcium-channel blockers like amlodipine and felodipine
- Cardiac glycosides like Digoxin
- Nitrodilators like isosorbide dinitrate, isosorbide mononitrate, and nitroglycerin
- Potassium-channel blockers like amiodarone, dofetilide, and dronedarone
Diabetes alternatives
Guidelines from the University of Pittsburgh Medical Center state that many diabetes medications can be continued up until the day before surgery. Many diabetes treatments must be skipped or dose-adjusted on the day of surgery because of fasting.
In general, diabetes treatments considered safe within a day or two of the intraoperative period include:
It’s very important to consult your surgical and diabetes care team for personalized medical advice on whether to continue, or how to continue, diabetes treatment up until the day of surgery. “While alternative blood sugar-lowering medications exist, they may come with their own surgical risks or side effects,” Hippley says. “This makes a last-minute switch less ideal and against standards.”
When and how to restart Jardiance after surgery
Dr. Ali says that in most cases, people can resume taking Jardiance 24–48 hours after surgery, provided they have also been cleared to start eating and walking and find that they are eating normally. Postoperative medication protocols can vary from person to person, so it’s important to seek personalized medical advice from a healthcare provider familiar with your medical history, health conditions, and other medications.
Bottom line: Always get clearance from your healthcare provider before restarting Jardiance after surgery.
Special considerations when taking Jardiance with an unplanned surgery
There are situations when a person doesn’t have time to wean off Jardiance before surgery. The good news is that emergency procedures are a fact of life for surgical teams. These healthcare professionals take extra precautions for unplanned surgeries.
“The patient is treated as if they have a full stomach, and different techniques are used to induce anesthesia safely,” Dr. Ali says. “Furthermore, additional precautions may be needed to monitor blood glucose and blood pressure more closely.”
The most important thing is for the surgeon to know that their patient is on Jardiance. Whenever possible, a list of all prescription and over-the-counter medications and supplements you take should be shared with your healthcare provider before an unplanned surgery. Some people also wear medical bracelets to share information about diagnoses (like Type 2 diabetes or heart failure). Older adults, or anyone with a serious condition like heart failure, should also keep a list of medications and emergency contacts in accessible places like a purse, wallet, or inside the front door.
- Sodium-glucose co-transported type-2 inhibitors: pharmacology and peri-operative considerations, Anaesthesia (2018)
- Blood pressure targets in perioperative care: Provisional considerations based on a comprehensive literature review, Hypertension (American Heart Association) (2018)
- Treating low blood pressure during surgery may decrease risk of developing postoperative delirium, American Society of Anesthesiologists (2021)
- JARDIANCE- empagliflozin tablet, film coated, DailyMed (2025)
- JARDIANCE® (empagliflozin tablets), for oral use, Food and Drug Administration (2023)
- Preoperative management of cardiovascular medications: A society for perioperative assessment and quality improvement (SPAQI) consensus statement, Mayo Clinic Proceedings (2022)
- Diabetes medicines before surgery, University of Pittsburgh Medical Center (2025)