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empagliflozin

Sold as Jardiance. Class: Sodium-glucose co-transporter 2 (SGLT2) inhibitors. First FDA approval 08/01/2014: 12 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (82/100)

Safety ×35%
A
Evidence ×25%
C
Regulatory ×15%
B
Money & lawsuits ×15%
D
Options ×10%
A

Safety: 100

Evidence: 68

Regulatory history: 81

Money & lawsuits: 55

Options: 100

Independent reviews and post-approval warnings

WHO Essential Medicine

Listed on the WHO Model List of Essential Medicines: a global expert panel judged it among the medicines a health system should always have, on evidence of value, not marketing.

What the FDA label says

Approved uses

is indicated: to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure. to reduce the risk of sustained decline in eGFR, end-stage kidney disease, cardiovascular death, and hospitalization in adults with chronic kidney disease at risk of progression. to reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease. as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus. JARDIANCE is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated: To reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure. ( 1 ) To reduce the risk of sustained decline in eGFR, end-stage kidney disease, cardiovascular death, and hospitalization in adults with chronic kidney disease at risk of progression. ( 1 ) To reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease. ( 1 ) As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and o...

Contraindications

is contraindicated in patients: with a hypersensitivity to empagliflozin or any of the excipients in JARDIANCE, reactions such as angioedema have occurred [see Warnings and Precautions (5.8) ] . Hypersensitivity to empagliflozin or any of the excipients in JARDIANCE. ( 4 )

Warnings and precautions

Diabetic Ketoacidosis in Patients with Type 1 Diabetes Mellitus and Other Ketoacidosis: Consider ketone monitoring in patients with type 1 diabetes mellitus and consider ketone monitoring in others at risk for ketoacidosis, as indicated. Assess for ketoacidosis regardless of presenting blood glucose levels and discontinue JARDIANCE if ketoacidosis is suspected. Monitor patients for resolution of ketoacidosis before restarting. ( 5.1 ) Volume Depletion: Before initiating JARDIANCE, assess volume status and renal function in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for signs and symptoms during therapy. ( 5.2 ) Urosepsis and Pyelonephritis: Evaluate patients for signs and symptoms of urinary tract infections and treat promptly, if indicated. ( 5.3 ) Hypoglycemia: Adult patients taking an insulin secretagogue or insulin may have an increased risk of hypoglycemia. In pediatric patients 10 years of age and older, the risk of hypoglycemia was higher regardless of insulin use. Consider lowering the dosage of insulin secretagogue or insulin to reduce the risk of hypoglycemia when initiating JARDIANCE. ( 5.4 ) Necrotizing Fasciitis of t...

Adverse reactions (label)

The following important adverse reactions are described below and elsewhere in the labeling: Diabetic Ketoacidosis in Patients with Type 1 Diabetes Mellitus and Other Ketoacidosis [see Warnings and Precautions (5.1) ] Volume Depletion [see Warnings and Precautions (5.2) ] Urosepsis and Pyelonephritis [see Warnings and Precautions (5.3) ] Hypoglycemia [see Warnings and Precautions (5.4) ] Necrotizing Fasciitis of the Perineum (Fournier's Gangrene) [see Warnings and Precautions (5.5) ] Genital Mycotic Infections [see Warnings and Precautions (5.6) ] Hypersensitivity Reactions [see Warnings and Precautions (5.8) ] Most common adverse reactions (5% or greater incidence) were urinary tract infections and female genital mycotic infections ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Boehringer Ingelheim Pharmaceuticals, Inc. at 1-800-542-6257 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in pract...

Recent major label changes

Indications and Usage ( 1 ) 9/2023 Dosage and Administration ( 2.2 ) 9/2023 Dosage and Administration ( 2.3 ) 6/2023 Dosage and Administration ( 2.4 ) 9/2023 Warnings and Precautions ( 5.1 ) 9/2023 Warnings and Precautions ( 5.4 ) 6/2023 Warnings and Precautions ( 5.7 ) 9/2023

Source: FDA SPL label for Jardiance (Aphena Pharma Solutions - Tennessee, LLC), effective 20260617. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

67,251reports that mention this drug
67,027of those blame this drug, not another one the person was taking
61%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
5.0%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Diabetic Ketoacidosis · 3,902Nausea · 3,595Diarrhoea · 3,254Blood Glucose Increased · 3,199Weight Decreased · 2,928Fatigue · 2,888Off Label Use · 2,788Vomiting · 2,712Dizziness · 2,669Dyspnoea · 2,390Drug Ineffective · 2,378Fungal Infection · 2,155Euglycaemic Diabetic Ketoacidosis · 2,049Urinary Tract Infection · 2,024Headache · 1,939

Reports per year

20192020202120222023202420252026
5,4915,4596,2447,5339,1729,8629,6045,000

2,139 reports blaming this drug for every million Medicare prescriptions filled, which is 0.8× the typical drug on this site. (24,322 reports in 2024–2026, against 11,368,280 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

2recall actions on file
2 / 2brand / generic applications
6label changes since 2021
NoREMS program
DateClassFirmReason
03/2023Class IIBoehringer Ingelheim Pharmaceuticals, Inc.Labeling: Label Mix-up
01/2022Class IICARDINAL HEALTHCARECGMP Deviations: Products were exposed to temperatures outside of the products labeled storage conditions.

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

408randomized trials (PubMed)
47systematic reviews
640registered trials
39%of completed trials posted results
5%terminated or withdrawn
40%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $14,327,291 in payments to US physicians and hospitals tied to this drug across 238,298 transactions (Jardiance $14,327,291).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

2,543,331Medicare Part D patients (2024)
11,368,280prescriptions filled
$1,006average cost per fill
$11,436Mtotal Medicare spend

Same-class alternatives

bexagliflozincanagliflozinertugliflozinsotagliflozin

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are diabetic ketoacidosis, nausea, diarrhoea, blood glucose increased. How would we recognize and handle those?
  2. Why this one over bexagliflozin, canagliflozin, dapagliflozin? What would make you pick one of those instead?
  3. The manufacturer pays physicians heavily to promote this drug. Have you received anything from them?
  4. What result are we expecting, by when, and what is the plan if it does not happen?
  5. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)