I Don’t Mean to Pick on Jardiance, But Prescribers Have a Choice: Memorize Published Side Effects or Understand How Drugs Work

So, here’s another Jardiance story. I saw a new patient the other day who has heart failure with reduced ejection fraction. His cardiology provider, who is a nurse practitioner, working in a cardiology office, had prescribed him 12.5 mg of carvedilol twice daily. He was unable to tolerate that dose because his blood pressure kept bottoming out. So he ended up taking half that dose. Then, for reasons my patient didn’t understand, he was prescribed Jardiance. He is not a diabetic, but I explained to him that this medicine has been shown to reduce mortality in non-diabetics with heart disease. It does nothing to help the symptoms of heart failure that a diuretic couldn’t do.

He took his new medicine for a couple of days and ended up in the emergency room in near shock. The medicine was stopped, and he told me he still doesn’t understand what happened.

I explained to him that Jardiance works by making you urinate out glucose, whether you are a diabetic or not. That glucose in the urine, because of osmosis, pulls water with it. This results in dehydration. His carvedilol prevents his pulse and blood pressure reflexes to fight the falling numbers triggered by the dehydration. I told him that when carvedilol first came out, doctors were warned that they had to observe patients for 30 minutes after their first dose, which had to be taken in the office. That cautionary statement fell by the wayside, but an old duffer like me remembers that we used to think of it as a scary drug. Combined with something that can dehydrate you, it may come in the limelight again, because both of these drugs are commonly used together in heart failure patients.