{"id":634242,"date":"2025-11-06T15:28:39","date_gmt":"2025-11-06T20:28:39","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634242"},"modified":"2025-11-06T15:31:52","modified_gmt":"2025-11-06T20:31:52","slug":"jardiance-and-surgery","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/jardiance-and-surgery\/","title":{"rendered":"What you should know about taking Jardiance before surgery"},"content":{"rendered":"

Jardiance<\/span><\/a> (empagliflozin) is a prescription medication that helps <\/span>lower blood sugar<\/span><\/a> in people with <\/span>Type 2 diabetes mellitus<\/span><\/a>. It is also approved by the Food and Drug Administration (FDA) to reduce the risk of cardiovascular death in adults diagnosed with <\/span>heart failure<\/span><\/a> 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 <\/span>chronic kidney disease<\/span><\/a> (CKD). When taken as directed, <\/span>Jardiance<\/span><\/a> is a safe and effective medication, but it is one of several medications that can cause extra risks during surgery.\u00a0\u00a0<\/span><\/p>\n

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Why Jardiance may be a concern before surgery<\/span><\/h2>\n

Jardiance belongs to a class of drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors.<\/span> SGLT2 inhibitors<\/span><\/a> primarily help flush out excess blood glucose through the urine, but they also have some indirect effects, like <\/span>lowering blood pressure<\/span><\/a>. And it\u2019s this combination of facts that makes Jardiance a concern before surgery.\u00a0<\/span><\/p>\n

The main reason for stopping Jardiance before surgery is that the stress of surgery can cause <\/span>blood sugar<\/span><\/a> instability that leads to <\/span>diabetic ketoacidosis<\/span><\/a>, according to<\/span> Mir Ali<\/span><\/a>, MD<\/span>, 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\u2019s effects on blood pressure.<\/span><\/p>\n

Risk of euglycemic diabetic ketoacidosis (EDKA)\u00a0<\/span><\/h3>\n

Many people with diabetes already know diabetic ketoacidosis (DKA) as a <\/span>serious complication<\/span><\/a> 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, <\/span>hyperglycemia<\/span><\/a> (high glucose levels) is a warning sign of DKA. But with euglycemic ketoacidosis, blood sugar levels may look normal, potentially delaying treatment.\u00a0<\/span><\/p>\n

Here\u2019s <\/span>why use of SGLT2 inhibitors causes an increased risk<\/span><\/a> 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. \u201cBlood sugar levels may look normal or only mildly elevated, instead of very high,\u201d says<\/span> Kaitlin Hippley<\/span><\/a>, a registered dietitian and certified diabetes educator in Cleveland, Ohio. \u201cHowever, the body still has an <\/span>insulin deficiency<\/span><\/a>, which causes it to break down fat for energy and produce ketones. These ketones then build up and make the blood dangerously acidic.\u201d If not treated promptly, euglycemic DKA can be life-threatening.<\/span><\/p>\n

Low blood pressure<\/span><\/h3>\n

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<\/span> has been linked<\/span><\/a> to unfavorable surgical outcomes. For instance, the<\/span> American Society of Anesthesiologists<\/span><\/a> has found that <\/span>low blood pressure<\/span><\/a> during surgery can increase the risk of postoperative delirium. As listed on the <\/span>drug\u2019s label<\/span><\/a>, Jardiance can contribute to volume depletion or dehydration, which may explain the risk of low blood pressure during surgery.<\/span><\/p>\n

Jardiance before surgery: Official guidelines<\/span><\/h2>\n

The<\/span> prescribing information<\/span><\/a> 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\u2019s important to follow the personalized medical guidance of your diabetes care team and surgical team.\u00a0<\/span><\/p>\n

Jardiance alternatives before surgery<\/span><\/h2>\n

First things first: Never stop, start, or switch prescription diabetes or heart failure medications without the guidance of your healthcare provider. It\u2019s important to work with your surgical team or diabetes care team when considering a Jardiance alternative in the days or weeks before surgery.<\/span><\/p>\n

Other medications that are <\/span>not<\/span><\/i> recommended before surgery include other SGL2 inhibitors like <\/span>Invokana<\/span><\/a> (\u200ccanagliflozin), <\/span>Farxiga<\/span><\/a> (dapagliflozin), and <\/span>Steglatro<\/span><\/a> (\u200certugliflozin.) <\/span>Glucagon-like peptide-1 (GLP1) receptor agonists<\/span><\/a>, like <\/span>Ozempic<\/span><\/a> (semaglutide), <\/span>Rybelsus<\/span><\/a> (semaglutide), <\/span>Mounjaro<\/span><\/a> (tirzepatide), and <\/span>Trulicity<\/span><\/a> (dulaglutide), are stopped in advance of surgery too.<\/span><\/p>\n

Heart failure alternatives<\/span><\/h3>\n

A<\/span> 2022 review of cardiovascular medications<\/span><\/a> concluded that several drug types are typically safe to take before major surgery, including the following:<\/span><\/p>\n