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Jardiance vs Metformin
Introduction
For patients with type 2 diabetes, certain drugs that affect the balance of insulin and glucose in the body can help in managing blood sugar levels. Jardiance and Metformin are two such drugs that are prescribed for this purpose. They each have different mechanisms of action, but both aim to regulate blood glucose levels in patients with diabetes. Jardiance is a sodium-glucose co-transporter 2 (SGLT2) inhibitor which works by preventing the kidneys from reabsorbing glucose back into the blood and thus promoting its excretion through urine. On the other hand, Metformin falls under a class of medications called biguanides and operates primarily by reducing liver's production of glucose while also improving insulin sensitivity in cells throughout your body.
Jardiance vs Metformin Side By Side
| Attribute | Jardiance | Metformin |
|---|---|---|
| Brand Name | Jardiance | Metformin |
| Contraindications | Should not be taken if you are taking or have recently been treated with drugs known to interfere with blood sugar control such as corticosteroids or thyroid hormones. Increased risk for lactic acidosis in patients with severe kidney impairment, liver disease, alcoholism, or heart failure. | Increased risk for lactic acidosis in patients with severe kidney impairment, liver disease, alcoholism, or heart failure. Should not be taken if you are taking or have recently been treated with drugs known to interfere with blood sugar control such as corticosteroids or thyroid hormones. |
| Cost | Around $570 for a 30-tablet pack of 10 mg | Around $35 for a 60-tablet supply of 500 mg (Glucophage) |
| Generic Name | Empagliflozin | Metformin |
| Most Serious Side Effect | Symptoms of allergic reactions, dehydration, yeast infections, urinary tract infection, hypoglycemia when combined with insulin or medicines that increase insulin production. | Lactic acidosis, which can cause weakness, trouble breathing, abnormal heartbeats, unusual muscle pain, stomach discomforts or feeling cold. |
| Severe Drug Interactions | Corticosteroids, thyroid hormones | Corticosteroids, thyroid hormones |
| Typical Dose | 10-25 mg/day | 500 mg once or twice per day, up to a maximum of 2000-2500 mg per day |
What is Jardiance?
Empagliflozin (the generic name for Jardiance) is a relatively new type of medication in the SGLT2 inhibitors class, approved by the FDA in 2014. It was developed to manage Type 2 diabetes and works by helping kidneys remove glucose from the bloodstream, effectively lowering blood sugar levels while also assisting with weight loss and reducing blood pressure. On the other hand, Metformin has been around much longer—it's a biguanide antihyperglycemic agent that was first approved by the FDA back in 1995. Metformin decreases hepatic glucose production and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Both medications are used as an initial treatment for Type 2 diabetes but they function differently: while Jardiance acts on your kidneys, Metformin works primarily on your liver and muscles. Consequently, they have different side effects—Jardiance can potentially lead to urinary tract infections or dehydration due to its mechanism of action; whereas Metformin may cause gastrointestinal issues like nausea or diarrhea.
What conditions is Jardiance approved to treat?
Jardiance is approved for the treatment of various types of diabetes:
- Type 2 Diabetes Mellitus (T2DM), where it's used as an adjunct to diet and exercise to improve glycemic control.
- Cardiovascular death risk reduction in T2DM patients with established cardiovascular disease.
- Chronic kidney disease, where it's used to reduce the risk of sustained estimated glomerular filtration rate decline, end-stage kidney disease (ESKD), and cardiovascular death.
How does Jardiance help with these illnesses?
Jardiance, like metformin, is used to manage type 2 diabetes. It operates by blocking the reabsorption of glucose in the kidneys, which then promotes a higher amount of glucose excretion via urine and subsequently lowers blood sugar levels. Glucose is a simple sugar that serves as a primary energy source for cells throughout the body. In individuals with type 2 diabetes, their bodies either resist the effects of insulin - a hormone regulating the movement of sugar into cells - or they don't produce enough insulin to maintain normal glucose levels.
By increasing glucose excretion and reducing its presence in blood circulation, Jardiance can help manage high blood sugar levels associated with type 2 diabetes. It's important to note that while it performs similar functions as Metformin, it uses different methods: Metformin works by decreasing liver production of glucose and improving your body's sensitivity towards insulin. Therefore, patients may prefer one over another based on side effects profiles or other personal considerations.
What is Metformin?
Metformin is a generic name for a drug commonly used to manage type 2 diabetes. It falls under the class of drugs known as biguanides, which work by reducing glucose production in the liver and enhancing insulin sensitivity in body tissues, thereby regulating blood sugar levels. Metformin was first approved by the FDA in 1995 and has since been widely recognized for its efficacy and affordability.
Unlike Jardiance, metformin does not act on sodium-glucose transport proteins (SGLTs) found primarily in kidney tubules; therefore it does not increase urinary glucose excretion like SGLT2 inhibitors such as Jardiance do. The different mechanisms of action mean that metformin's side-effect profile differs from that of Jardiance: common side effects include digestive issues rather than dehydration or urinary tract infections. Moreover, unlike Jardiance which may lead to weight loss, metformin is typically weight-neutral.
Over time, metformin has proven beneficial not only for managing diabetes but also improving associated conditions like polycystic ovary syndrome (PCOS), making it a versatile choice among antidiabetic medications.
What conditions is Metformin approved to treat?
Metformin is approved for the management of:
- Type 2 diabetes, being one of the most widely-prescribed first-line treatments
- Polycystic ovary syndrome (PCOS), as it aids in regulating menstrual cycles and reducing insulin levels.
How does Metformin help with these illnesses?
Metformin, a first-line medication for the treatment of type 2 diabetes, works by decreasing glucose production in the liver and increasing insulin sensitivity in peripheral tissues. This process helps regulate blood sugar levels efficiently. Metformin's actions on glucose metabolism play key roles in its effectiveness as an anti-diabetic agent. Unlike Jardiance which acts by preventing reabsorption of glucose from the kidneys - thereby excreting excess sugar through urine - metformin is directly involved with improving the body's natural response to insulin, which might be more beneficial for patients whose primary issue is insulin resistance rather than overproduction of glucose. Therefore, Metformin may be preferred when a patient does not respond well to SGLT2 inhibitors like Jardiance or it may also be combined with such medications for optimal control of blood sugar levels.
How effective are both Jardiance and Metformin?
Both empagliflozin (Jardiance) and metformin have confirmed histories of efficacy in managing type 2 diabetes, with metformin being approved by the FDA several decades before Jardiance. They work differently to control blood sugar levels; thus, they may be prescribed under varying circumstances. Metformin's effectiveness has been demonstrated through numerous studies over several decades while Jardiance was directly studied in a double-blind clinical trial in 2013, showing similar efficacy for reducing HbA1c levels and similar safety profiles.
A systematic review from 2007 indicated that metformin is effective at controlling blood glucose levels without causing weight gain or hypoglycemia. It also suggested that it reduces diabetes-related complications and mortality rates. Given its long history, established benefits, and low cost, metformin is often the first-line treatment for individuals diagnosed with type-2 diabetes.
In contrast to this longevity of use on the market for metformin, a recent meta-analysis published in 2020 showed that Jardiance not only effectively controls blood glucose but also provides cardiovascular benefits. Although typically considered as an adjunctive treatment when first-line therapies such as metformin aren't enough to manage patients' glycemic control properly or if there's a need to consider cardiovascular outcome advantages due its unique mechanism of action; blocking SGLT-2 receptors which leads to excretion of glucose via urine hence lowering blood sugar level.
However significant research involves both drugs being co-prescribed since data confirming their individual efficacies are robust yet combining them seems more beneficial leading to better glycemic control along with additional health benefits like reduction in body weight & BP seen especially with Jardiance use compared to others within same class or other classes.
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At what dose is Jardiance typically prescribed?
Oral dosages of Jardiance range from 10-25 mg/day, but studies have indicated that 10 mg/day is sufficient for treating type 2 diabetes in most people. There's no pediatric dosage recommended as it hasn't been studied adequately in children yet. If patients do not see an adequate lowering of blood sugar levels after a few weeks, the dose can be increased to a maximum of 25mg once daily. This should always be done under the supervision and direction of their doctor or healthcare provider.
On the other hand, Metformin dosing often starts at 500mg twice a day or 850mg once a day for adults with type 2 diabetes, though doses can increase based on tolerance and effectiveness up to a maximum of about 2000-2550mg per day divided into two or three doses.
At what dose is Metformin typically prescribed?
Metformin therapy is typically initiated at a dosage of 500 mg once or twice per day. If well tolerated, the dose can be gradually increased to a maximum of 2000-2500 mg per day, divided into two to three doses taken with meals. The dosage increase should be done in increments of 500 mg every week or every other week, up to a maximum daily dose of 2000-2500 mg depending on individual patient response and tolerability. It's important that Metformin always be taken as directed by your healthcare provider and is often dependent upon your body's response to treatment as well as any existing conditions such as kidney function.
What are the most common side effects for Jardiance?
Common side effects of Jardiance include:
- Urinary tract infections
- Yeast infections in both men and women
- Increased urination
- Thirstiness
- Nausea
- Fatigue
- Hypoglycemia (low blood sugar levels, especially when combined with insulin or sulfonylureas)
On the other hand, Metformin users may experience these common side effects:
- Diarrhea, nausea/vomiting, and gas
- Weakness or lack of energy
- Metallic taste in mouth
- Heartburn
It's essential to remember that every medication works differently for each individual. Always consult your healthcare provider regarding any concerns about side effects.
Are there any potential serious side effects for Jardiance?
While both Jardiance and Metformin are used for managing blood sugar levels in patients with type 2 diabetes, they do come with their unique side effects. For Jardiance:
- Symptoms of allergic reactions such as hives, difficulty breathing, swelling of face or throat
- Indications of dehydration like lightheadedness and low blood pressure
- Yeast infections in women and men
- Urinary tract infection
- Hypoglycemia when combined with insulin or medicines that increase insulin production
For Metformin:
- Lactic acidosis which can cause weakness, trouble breathing, abnormal heartbeats, unusual muscle pain, stomach discomforts or feeling cold.
- Hypoglycemia especially if taken together with other diabetic medications.
If you experience any severe symptoms from either medication reach out to your healthcare provider immediately. It's essential to understand how each drug affects you before making a decision on the best course of treatment.
What are the most common side effects for Metformin?
When comparing Jardiance to Metformin, the latter can typically cause:
- Stomach pain accompanied by nausea and vomiting
- Heartburn or a metallic taste in the mouth
- Decreased appetite leading to weight loss
- Diarrhea or constipation
- Headache and dizziness
- Weakness, fatigue, or sleep problems
- Mild rash
While these are common side effects of Metformin, they usually lessen over time as your body acclimates to the medication. Severe side effects are rare but if you experience symptoms such as muscle pain, slow heartbeat rate, or feel unusually cold it is advised that you seek immediate medical attention.
Are there any potential serious side effects for Metformin?
While Metformin is generally a safe and effective medication for controlling blood sugar levels in people with type 2 diabetes, there are instances where it can cause serious side effects. These may include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Symptoms of lactic acidosis: unusual muscle pain, trouble breathing, stomach pain (especially after meals), feeling cold (particularly in the arms and legs), dizziness or light-headedness, slow or irregular heart rate
- Severe nausea, vomiting or diarrhea that doesn't improve
- Feeling weak or tired
- Yellowing skin or eyes which could be signs of liver problems Should you experience any such symptoms while taking metformin, it's crucial to seek immediate medical attention.
Contraindications for Jardiance and Metformin?
Both Jardiance and Metformin, like other diabetes medications, can potentially worsen symptoms of hypoglycemia in some individuals. If you notice a sudden onset of dizziness, shakiness or increased hunger, these could be signs of low blood sugar and require immediate medical attention.
Neither Jardiance nor Metformin should be taken if you are taking or have recently been treated with drugs known to interfere with blood sugar control such as corticosteroids or thyroid hormones. Always inform your healthcare provider about the medications you're currently taking; such interfering drugs might need a period of adjustment before initiating therapy with Jardiance or Metformin to prevent dangerous interactions.
Additionally, both medications may increase risk for lactic acidosis - a serious metabolic condition. This risk is particularly high in patients who have severe kidney impairment, liver disease, alcoholism or heart failure. It's important that your physician is aware of any existing conditions before prescribing either drug.
How much do Jardiance and Metformin cost?
For the brand name versions of these drugs:
- The price for a 30-tablet pack of Jardiance (10 mg) averages around $570, which works out to approximately $19/day.
- The price for a 60-tablet supply of Glucophage (500 mg), a brand-name version of metformin, is about $35, working out to roughly $0.58/day.
Thus, if you are prescribed Jardiance, it is significantly more expensive on a per-day treatment basis than Glucophage. However, cost should not be your primary consideration in determining which drug is right for you; effectiveness and side effect profile must also be taken into account.
For the generic versions of these medications:
- Generic metformin costs significantly less than its branded counterpart with prices ranging from as low as $4 for sixty 500mg tablets at some pharmacies which equates to just over $.06/day.
- There's currently no generic equivalent available for Jardiance so patients would need to pay the full retail price unless covered by insurance or assistance programs.
Popularity of Jardiance and Metformin
Empagliflozin, available under the brand name Jardiance, has seen a steady increase in usage since its introduction. In 2020, Jardiance was prescribed to approximately 1.5 million people in the United States. With its proven benefits on cardiovascular outcomes and kidney health in patients with type 2 diabetes, it is increasingly becoming an important player among antidiabetic drugs.
On the other hand, Metformin remains the most commonly prescribed medication for type 2 diabetes globally due to its long history of use, efficacy and cost-effectiveness. In the US alone, metformin was prescribed to around 80 million people in 2020. It accounts for nearly one-third of all prescriptions for oral antidiabetic therapy. Despite newer medications like Jardiance entering the market with additional benefits beyond blood sugar control, metformin continues to hold strong as first-line therapy for most patients with type 2 diabetes.
Conclusion
Both Jardiance (empagliflozin) and Metformin have extensive records of usage in patients with type 2 diabetes, supported by numerous clinical studies indicating that they are more effective than placebo treatments. They can be combined to enhance blood glucose control, but this requires careful medical evaluation because each drug has its unique contraindications. They work differently: metformin reduces the amount of sugar your liver makes and helps your body use insulin better while Jardiance works on the kidneys to help remove excess glucose from your body.
Metformin is often considered a first-line treatment option for type 2 diabetes due to its effectiveness, safety profile, cost-effectiveness as it's available in generic form, and minimal risk of causing low blood sugar. On the other hand, Jardiance is typically used when metformin alone does not provide adequate glycemic control or in patients who cannot tolerate metformin.
While both drugs generally require an adjustment period where effects may not be noticeable immediately, their side effect profiles differ somewhat. Both are usually well-tolerated; however common side effects for metformin include gastrointestinal issues like diarrhea and nausea while Jardiance may cause urinary tract infections and yeast infections more frequently. It's important for patients taking either medication to closely monitor their blood sugar levels especially when starting treatment or adjusting dosage.
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Refrences
- Scott, L. J. (2014, October). Empagliflozin: A Review of Its Use in Patients with Type 2 Diabetes Mellitus. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0298-1
- Frampton, J. E. (2018, June 27). Empagliflozin: A Review in Type 2 Diabetes. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-0937-z
- Baker, C., Retzik-Stahr, C., Singh, V., Plomondon, R., Anderson, V., & Rasouli, N. (2021, January). Should metformin remain the first-line therapy for treatment of type 2 diabetes?. Therapeutic Advances in Endocrinology and Metabolism. SAGE Publications.http://doi.org/10.1177/2042018820980225
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- Ashraf, S., Upreti, P., Karki, S., Khan, M., & Nasr, R. (2022, April 17). Metformin-Associated Lactic Acidosis: A Case Report and Review. Cureus. Springer Science and Business Media LLC.http://doi.org/10.7759/cureus.24220
- Pai, R. P. R., & Kangath, R. V. (2019, February 15). Bilateral gangrene of fingers in a patient on empagliflozin: First case report. World Journal of Diabetes. Baishideng Publishing Group Inc.http://doi.org/10.4239/wjd.v10.i2.133
- Gignilliat, J. (1996, October). Re: TDE article, Pharmacy Update, "Metformin: A Biquanide". The Diabetes Educator. SAGE Publications.http://doi.org/10.1177/014572179602200502