Jardiance (empagliflozin) belongs to a class of drugs called SGLT2 inhibitors, short for sodium-glucose cotransporter-2 inhibitors. This drug class works by targeting the kidneys to lower blood sugar, but Jardiance is now FDA-approved for several conditions beyond type 2 diabetes, including heart failure and chronic kidney disease.
How SGLT2 Inhibitors Work
Your kidneys filter about 180 grams of glucose from your blood every day. Normally, a protein called SGLT2 recaptures about 90% of that glucose from the fluid that will become urine and sends it back into your bloodstream. This is useful when glucose levels are normal, but in someone with high blood sugar, it means the kidneys keep recycling excess glucose instead of letting the body get rid of it.
Jardiance blocks that SGLT2 protein. With the transporter disabled, your kidneys pass the extra glucose out through urine instead of reabsorbing it. The result is lower blood sugar without directly affecting insulin production or sensitivity, which makes SGLT2 inhibitors fundamentally different from older diabetes drug classes like metformin or sulfonylureas.
Other Drugs in the Same Class
Jardiance is one of three main SGLT2 inhibitors on the market. The others are canagliflozin (Invokana) and dapagliflozin (Farxiga). All three share the same basic mechanism of blocking glucose reabsorption in the kidneys, though they differ in their specific FDA-approved uses and dosing. You can recognize drugs in this class by the “-gliflozin” ending in their generic names.
What Jardiance Is Approved to Treat
Jardiance started as a type 2 diabetes medication, but its approved uses have expanded significantly. The FDA currently approves it for four indications:
- Type 2 diabetes: As an add-on to diet and exercise to improve blood sugar control in adults and children aged 10 and older.
- Cardiovascular risk reduction: To reduce the risk of cardiovascular death in adults with type 2 diabetes who already have established heart disease.
- Heart failure: To reduce the risk of cardiovascular death and hospitalization in adults with heart failure, regardless of whether they have diabetes.
- Chronic kidney disease: To slow kidney decline and reduce the risk of end-stage kidney disease and cardiovascular death in adults with CKD at risk of progression.
The heart failure and kidney disease approvals are notable because they mean Jardiance is now prescribed to people who don’t have diabetes at all. The cardiovascular benefits were first demonstrated in a large trial called EMPA-REG OUTCOME, which found that empagliflozin reduced the combined risk of heart failure hospitalization or cardiovascular death by 34% compared to placebo over three years. In practical terms, treating 35 patients for three years prevented one of those events.
Common Side Effects
Because SGLT2 inhibitors push extra sugar into the urine, they create an environment where yeast and bacteria can thrive. The most common side effects reflect this. In clinical trials, genital yeast infections affected about 5 to 6% of women taking Jardiance compared to 1.5% on placebo, and about 2 to 3% of men compared to 0.4% on placebo. Urinary tract infections occurred in roughly 8 to 9% of patients, slightly above the 7.6% rate seen with placebo. Most people who experienced these infections did not need to stop taking the medication.
A rarer but serious risk is ketoacidosis, a condition where the blood becomes dangerously acidic. This has been reported across all SGLT2 inhibitors, including Jardiance, in postmarketing surveillance. What makes it tricky is that it can occur even when blood sugar levels appear relatively normal (below 250 mg/dL), which is unusual for ketoacidosis and can delay recognition. Symptoms like nausea, vomiting, abdominal pain, excessive tiredness, and difficulty breathing warrant immediate medical attention.
Kidney Function Requirements
Since Jardiance works through the kidneys, your kidney function determines whether it’s appropriate for you. Kidney function is measured by a blood test called eGFR (estimated glomerular filtration rate), where higher numbers mean better function. Jardiance should not be started if your eGFR is below 45, and it’s fully contraindicated below 30. If kidney function drops persistently below 45 while you’re already taking it, the medication is typically discontinued. No dose adjustment is needed as long as eGFR stays at 45 or above.