Jardiance for heart failure: How it works, effectiveness & more

One of the most remarkable stories in medicine over the past few years has been the expanding use of a diabetes drug class as therapy for heart failure. Jardiance (empagliflozin) is one of them. The drug was developed for the treatment of Type 2 diabetes mellitus and then found to be remarkably beneficial for treating congestive heart failure, even for those without diabetes. The story of this drug and its class is still being written, but thus far, it has captivated the medical community for its various uses.

What is Jardiance?

Jardiance, a brand name of the generic drug empagliflozin, is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. The drug and its fellow SGLT2 inhibitors, Farxiga (dapagliflozin), Invokana (canagliflozin), Steglatro (ertugliflozin), and Brenzavvy (bexagliflozin), are approved by the Food and Drug Administration (FDA) for treatment of Type 2 diabetes. As Jardiance and other SGLT2 inhibitors were studied further, additional benefits came to be proven, resulting in new indications. But unlike the other drugs, Jardiance has evidence to support its different uses. 

Jardiance was initially approved to treat Type 2 diabetes in 2014 but has achieved the following additional FDA approvals in the years since:

• In 2016, it was approved to reduce the risk of cardiovascular death in adults with Type 2 diabetes.
• In 2021, it was approved to treat adults with heart failure and reduced ejection fraction, which happens when the heart’s left ventricle isn’t pumping blood as well as it should when it contracts. 
• In 2022, it was approved to treat adults with heart failure regardless of ejection fraction.
• In 2023, it was approved for treating Type 2 diabetes in children ages 10 and older as well as for treating adults with chronic kidney disease.

Jardiance for heart failure

SGLT2 inhibitors increase the excretion of sodium and glucose from the body by telling the kidneys to turn off their sodium-glucose cotransporters, thereby allowing these substances to spill out in the urine. This explains how the drugs work for diabetes—they lower blood glucose levels by eliminating sugar from the body via urination. An important nuance of the mechanism of SGLT2 inhibitors is that they lower high glucose levels but do not cause normal glucose levels to drop too low. Therefore, by themselves, they do not cause hypoglycemia for users with or without diabetes.

The reason Jardiance works for heart failure is that, by increasing sodium and glucose content in the urine, the drug also increases fluid excretion in the urine. The elimination of excess fluid can be helpful in cases of congestive heart failure (CHF). Symptoms of CHF center around fluid overload, including lower leg swelling, shortness of breath with activity, and difficulty breathing when lying flat.

CHF can be categorized into either having preserved heart strength or not. Left ventricular ejection fraction (EF) is often used to measure heart strength or blood pumping ability because the left chamber is the heart’s main pumping chamber. Measured by different radiographic tests, EF normally ranges from 55%–70% of the left ventricle’s blood volume being pumped out with each heartbeat. Fluid overload in CHF with reduced EF comes from a weakened heart muscle failing to circulate blood effectively, while excess fluid accumulates in CHF with preserved EF from a heart muscle that is typically too stiff.

Clinical studies have proven Jardiance’s worth in both types of CHF. With reduced EF, empagliflozin was associated with a reduced risk of cardiovascular death and reduced risk of hospitalization for CHF when compared with placebo. When a similar, double-blind study was done on patients with CHF and a preserved EF, those risk reductions were seen again. Healthcare providers now prescribe Jardiance for patients with CHF of either variety, preserved or reduced ventricular ejection fraction, along with other treatment options. In addition to the FDA indication, national guidelines support the use of SGLT2 inhibitors for heart failure as a standard of care.

Jardiance dosages for heart failure without diabetes

While understanding the mechanism can seem complicated, the dosing of Jardiance for heart failure without diabetes is quite simple. Jardiance is taken as a 10-milligram (mg) tablet once daily for use in adult patients with heart failure. That is the starting, maintenance, and maximum dose indicated for this disease. However, it can be dosed at a higher level, 25 mg once daily, for the management of Type 2 diabetes. If you have both CHF and Type 2 diabetes, your healthcare provider could recommend increasing the dose to 25 mg once daily if the lower dose is ineffective for glucose control.

The effects of Jardiance on the kidneys’ handling of sodium, glucose, and fluid reach a peak effect within a couple of hours of taking the tablet. Those actions can last to some degree for up to three days. The fast-acting and sustained nature is noteworthy. Medical providers may advise stopping Jardiance three days prior to surgeries to reduce the risk of dehydration during fasting states.

Jardiance side effects & warnings

It is not all roses with Jardiance. Like other SGLT2 inhibitors, the drug has some side effects and drug interactions that you need to know. Be sure to talk to your healthcare team about how these negative attributes of Jardiance apply to you, as the following side effects highlight major issues and are not comprehensive or applicable to each individual.

Common side effects of Jardiance

Common, but not necessarily Jardiance side effects include:

• Urinary tract infections (UTIs)
• Genital yeast infections
• Urinary frequency
• Joint pain
• Nausea
• Cholesterol elevation

Serious side effects of Jardiance

See your healthcare provider immediately for serious side effects of Jardiance, which include:

• Acute kidney injury
• Allergic reactions
• Serious urinary tract infections
• Ketoacidosis
• Dehydration
• Orthostatic hypotension (low blood pressure with position changes)
• Fournier gangrene (a life-threatening infection of the genital area)
• Lower limb complications requiring amputation

Drug interactions with Jardiance

Jardiance may negatively interact with the following medications:

• Insulin: Raises hypoglycemia (low blood sugar) risk
• Sulfonylureas: Raises hypoglycemia risk
• Diuretics: Increases the chance of dehydration
• Lithium: May reduce lithium levels 

Who should not take Jardiance for heart failure?

The Jardiance drug label lists various warnings about the drug, and certain populations should take it with close oversight from a healthcare professional or avoid taking it altogether. Do not take Jardiance for heart failure if you have had a prior allergic hypersensitivity reaction, including angioedema, to the drug or class. People who are pregnant or planning to become pregnant should not take Jardiance, as it may harm an unborn baby. Do not breastfeed while taking Jardiance.

Patients ages 75 and older with renal impairment may have diminished glycemic efficacy when taking Jardiance, causing an incidence of volume depletion-related adverse reactions and urinary tract infections.

How much does Jardiance cost?

Jardiance is not cheap. A one-month supply of Jardiance can cost over $800 without insurance, but some insurance plans and most Medicare and Medicaid plans cover it. Some insurance plans may require you to try a less expensive drug before Jardiance, though, and see whether that works before approving coverage of Jardiance. 

Although there is no generic version of Jardiance available currently, there may be as early as 2025. In the meantime, there are ways to reduce the cost. A SingleCare coupon can reduce the cost by about $300. The manufacturer, Boehringer Ingelheim Pharmaceuticals, Inc., also offers a savings card that allows eligible participants to get the drug for as little as $10 a month.