Empagliflozin, known by the brand name Jardiance, is a prescription medication primarily used to manage certain chronic health conditions. Although its main purpose is not weight reduction, a loss of body weight is a frequently observed effect that interests many people beginning treatment. This weight change is a direct consequence of how the drug works within the body’s metabolic system. Understanding the drug’s mechanism, typical results, and associated safety warnings is essential for anyone considering or currently taking this medication.
Primary Medical Use
Empagliflozin is approved for several significant medical indications, extending well beyond its original use for managing blood sugar. The drug is prescribed as an adjunct to diet and exercise to help improve glycemic control in adults and children aged 10 and older who have type 2 diabetes mellitus. This approval focuses on lowering high blood sugar levels, which is a foundational goal of diabetes treatment.
The medication is also a valuable tool for cardiovascular and renal protection, regardless of blood sugar status. It is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure. It is also used to reduce the risk of cardiovascular death and hospitalization in adults with chronic kidney disease at risk of progression. These indications reflect the drug’s beneficial effects on the heart and kidneys, which are often compromised in individuals with type 2 diabetes.
The Mechanism Behind Weight Reduction
The weight reduction associated with empagliflozin stems from its function as a sodium-glucose co-transporter 2 (SGLT2) inhibitor. The SGLT2 protein is located in the proximal tubules of the kidneys and is responsible for reabsorbing approximately 90% of the glucose filtered from the blood back into the bloodstream. Empagliflozin works by blocking this transporter protein, effectively inhibiting the kidney’s ability to reclaim glucose.
By inhibiting SGLT2, the drug causes excess glucose to be excreted through the urine, a process known as glucosuria. This loss of glucose means a loss of calories for the body, resulting in a net caloric deficit. For patients with type 2 diabetes, this increased urinary glucose excretion can equate to losing 64 to 78 grams of glucose daily.
This consistent caloric loss, roughly equivalent to 256 to 312 calories per day, drives the gradual reduction in body weight. The initial weight loss is often amplified by a mild diuretic effect, as the excess glucose in the urine draws water with it, leading to fluid volume loss. Over time, the body compensates for the calorie deficit by breaking down stored fat, contributing to a reduction in fat mass.
Typical Weight Loss Outcomes
The weight loss experienced with empagliflozin is generally modest and tends to stabilize after several months of consistent use. Clinical trials indicate that patients typically experience a weight reduction in the range of 2% to 3% of their initial body weight over a treatment period. This percentage translates to an average loss of approximately 1.5 to 2 kilograms, or about 3 to 4.4 pounds, compared to placebo groups.
Higher doses of the drug, such as the 25 mg dose, may result in a slightly greater weight loss compared to the 10 mg dose, though the difference is not always substantial. The most noticeable reductions are often observed within the first 12 to 26 weeks of initiating therapy. After this period, the weight loss plateaus as the body adapts to the new metabolic state.
The weight loss is favorable in composition, primarily involving a reduction in fat mass and fluid retention. Analysis has shown significant reductions in waist circumference and markers of abdominal fat, which is often considered the most harmful type of fat. Maintaining this weight loss requires continued adherence to the medication and a consistent healthy lifestyle.
Important Safety Considerations
While empagliflozin offers significant benefits, patients should be aware of several safety considerations. The primary side effects are linked directly to the drug’s mechanism of action, involving glucose excretion in the urine. This increase in glucose concentration can lead to a higher risk of genital mycotic (yeast) infections and urinary tract infections.
Patients may also experience volume depletion, which can manifest as dehydration or low blood pressure, particularly when combined with other diuretic medications. Symptoms like dizziness, lightheadedness, or feeling faint can indicate a drop in blood pressure. Correcting any existing volume depletion is necessary before starting treatment with empagliflozin.
A rare but serious complication is euglycemic diabetic ketoacidosis (DKA), a life-threatening condition where the body produces high levels of blood acids called ketones. This condition can occur even when blood sugar levels are not extremely high, often remaining below the typical diagnostic threshold. Symptoms of DKA include nausea, vomiting, abdominal pain, and excessive thirst, requiring immediate medical attention. Patients must temporarily stop taking empagliflozin before a planned surgery or during an acute illness, such as a severe infection, to mitigate the risk of DKA.