Yes, Jardiance (empagliflozin) is FDA-approved to treat heart failure in adults. Specifically, it is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure. Originally approved in 2014 for type 2 diabetes, Jardiance received its heart failure indication in 2021 after large clinical trials demonstrated clear benefits, and it now works for heart failure patients regardless of whether they have diabetes.
What Types of Heart Failure It Treats
Jardiance covers the full spectrum of heart failure. Clinical trials tested it in two major populations: patients whose hearts pump weakly (reduced ejection fraction, 40% or below) and patients whose hearts pump with normal strength but don’t relax properly (preserved ejection fraction, above 40%). The FDA indication doesn’t distinguish between these types. If you have chronic heart failure with symptoms like shortness of breath or fatigue, Jardiance may be appropriate.
The 2024 expert consensus pathway from the American College of Cardiology lists SGLT2 inhibitors like Jardiance as part of the core treatment regimen for heart failure with reduced ejection fraction, recommended alongside other standard therapies. Notably, it’s recommended with or without diabetes, which is a shift from how people first heard about this drug.
How It Helps the Heart
Jardiance was originally designed to lower blood sugar by blocking a protein in the kidneys that reabsorbs sugar back into the blood. But its heart failure benefits go beyond glucose control. The drug promotes the excretion of both sodium and water, reducing the volume of fluid your heart has to pump. This takes pressure off the heart and helps relieve the fluid buildup that causes swelling, breathlessness, and fatigue.
This is why Jardiance works for heart failure patients who don’t have diabetes at all. The cardiac benefits come from its effects on fluid balance and sodium handling, not from blood sugar reduction.
What the Clinical Trials Found
Two major trials shaped the heart failure approval. The EMPEROR-Reduced trial enrolled patients with weakened heart pumping function, while the EMPEROR-Preserved trial enrolled patients with normal or near-normal pumping function. Both compared Jardiance to a placebo on top of standard heart failure medications.
In patients with preserved ejection fraction (50% or higher), Jardiance reduced the combined risk of cardiovascular death or hospitalization for heart failure by 17% compared to placebo. The benefit appeared across a range of heart function levels.
Beyond the hard clinical endpoints, patients on Jardiance also reported feeling better. In the preserved ejection fraction trial, symptom scores improved significantly at 12, 32, and 52 weeks compared to placebo. At 12 weeks, patients taking Jardiance were 23% more likely to experience a meaningful improvement in their symptoms and 15% less likely to experience a meaningful worsening. These improvements held steady through a full year of treatment.
Dosage for Heart Failure
The recommended dose for heart failure is 10 mg taken once daily. This is simpler than the diabetes dosing, where doctors sometimes increase the dose to 25 mg for better blood sugar control. For heart failure, you stay at 10 mg.
Jardiance can be started in patients with kidney function (measured by eGFR) as low as 20 mL/min/1.73 m², which means even people with significantly reduced kidney function can use it. This is important because heart failure and kidney disease frequently coexist.
Common Side Effects
Because Jardiance makes your kidneys excrete more fluid and sugar, the most common side effects follow from that mechanism. Genital yeast infections are more frequent, since sugar in the urine creates a favorable environment for yeast. Urinary tract infections can also occur, with symptoms like burning during urination, frequent urination, or cloudy urine.
Dehydration is another concern. Signs include increased thirst, dry mouth, lightheadedness, and dark urine. This risk is higher if you’re already taking diuretics (water pills), which many heart failure patients are. Severe diarrhea, vomiting, or heavy sweating can compound the problem.
A rarer but serious risk is diabetic ketoacidosis, where ketone levels in the blood rise dangerously. This is more relevant to patients who also have diabetes, but it can occasionally occur even with normal blood sugar levels. Symptoms include nausea, stomach pain, fatigue, trouble breathing, and a fruity odor on the breath. There is also a very rare risk of a severe infection in the genital area called necrotizing fasciitis, which requires immediate medical attention if you notice unusual redness, swelling, or pain in that region.
How It Fits Into Heart Failure Treatment
Jardiance is not a standalone therapy. It’s prescribed alongside other heart failure medications, including ACE inhibitors or their newer alternatives, beta-blockers, and mineralocorticoid receptor antagonists. Together, these drugs target different pathways that contribute to heart failure progression. Adding an SGLT2 inhibitor like Jardiance to this regimen provides an additional layer of protection that the other medications don’t fully cover.
For many patients, this means taking Jardiance on top of three or four other heart failure drugs. The clinical trials were designed this way: patients were already on standard therapy when Jardiance was added, and the benefits were measured on top of those existing treatments. The fact that it still showed significant reductions in hospitalizations and deaths, even with a strong background of other medications, is what makes it a meaningful addition to the treatment toolkit.