Jardiance and Ozempic Together: Pros and Cons

Can Jardiance and Ozempic Together better control your blood glucose and help you lose more weight OR does the combination expose you to more side effects?

Can Jardiance and Ozempic be taken together or do these drugs have important drug interactions and should be avoided?

Here are the answers!

What is Jardiance?

Jardiance is the brand name of Empagliflozin, marketed by Boehringer Ingelheim Pharmaceuticals. It is primarily used to treat diabetes as monotherapy or in combination with metformin or other diabetes medications.

It is also recommended in diabetic patients with established cardiovascular disease to reduce the risks of death due to a cardiovascular cause.

In addition, it has also been approved for the treatment of non-diabetic patients with heart failure to reduce their chances of hospitalization and death from a cardiovascular cause.

How does Jardiance work?

Jardiance is one of the potent inhibitors of SGLT2 receptors that are present in the renal tubules. It blocks the filtered glucose from the kidneys back into the plasma.

Hence, it allows the glucose to get excreted via urine.

This has two major effects on our bodies:

• It lowers blood glucose levels
• Loss of blood glucose in urine also attracts more water loss and hence it helps in fluid-overloaded conditions such as heart failure.

What are the important side effects of Jardiance?

Since Jardiance lowers blood glucose by acting on receptors present in the renal tubules, it will not be effective if a patient has compromised kidneys.

The manufacturer recommends not to use it in patients who have an eGFR of <30 ml/minute [Ref].

In addition, because it causes fluid loss from the body, it may increase your risk of developing acute renal failure.

Jardiance also increases your risk of developing genital yeast infections and urinary tract infections.

In addition, its use has been associated with euglycemic ketoacidosis. Euglycemic ketoacidosis is common in patients with poor insulin reserves.

Important drug interactions of Jardiance:

Jardiance may augment the effect of water pills (diuretics) and increases your risks of dehydration and renal failure.

It may increase your chances of developing hypoglycemia if you take it with insulin or concomitant insulin-secreting drugs like sulfonylureas.

It may interfere with certain urine tests.

What is Ozempic?

Ozempic is an injectable medicine that is administered subQ into the skin once a week. It is used to treat diabetes type 2 in addition to diet, exercise, metformin, or other diabetes medications.

Ozempic belongs to the class of drugs called GLP-1 analogs. GLP-1 analogs are a novel class of potent diabetes medications.

Ozempic is a lower-dose formulation of Semaglutide. Semaglutide is also approved as oral pills (Rybelsus) for treating diabetes and in high-dose once-weekly medicine for treating obesity.

How does Ozempic work?

Ozempic is very similar to endogenous incretin. It lowers blood glucose by enhancing insulin secretion in a glucose-dependent mechanism.

In addition, it delays gastric emptying. When the stomach contents are slowly poured into the small intestine, it reduces the glucose spikes after meals.

It also makes a person feel full and increases satiety. Its weight loss effects are thought to be primarily mediated by central mechanisms.

What are the critical side effects of Ozempic?

Ozempic use has been associated with pancreatitis. It is not recommended in patients with a history of active or recurrent pancreatitis.

Ozempic. like other GLP-1 analogs, has also been associated with medullary thyroid cancer. It is contraindicated in patients with a person or a family history of medullary thyroid cancer or MEN-2 syndrome.

It may worsen pre-existing diabetic eye disease and may also cause acute renal failure.

In addition, if given with concomitant insulin or other insulin-secreting drugs like sulfonylureas, it may increase your chances of developing hypoglycemia.

Important drug interactions of Ozempic:

Ozempic should not be combined with other GLP-1 analogs like Liraglutide (Saxenda or Victoza), Dulaglutide (Trulicity), or Exenatide.

It is also not indicated with concomitant DPP-IV inhibitors such as Januvia (Sitagliptin) and Galvus (Vildagliptin).

If given with insulin or insulin-secreting drugs, it may increase your chances of developing hypoglycemia.

Since it delays the emptying of gastric contents, it may impair the absorption of drugs.

Pros of Using Jardiance and Ozempic Together:

Jardiance is one of the potent SGLT2 inhibitors. It has been studied with various diabetes medications including metformin and sulfonylureas.

When used as a monotherapy, i.e. used alone, it lowers the A1C by 0.7 to 0.8%. In combination with metformin, its A1C-lowering effects are multiplied. When used with metformin, it lowers the A1C by -0.8% to -2.1%.

When given with insulin, it lowers the A1C by -0.7% to -1%.

However, Jardiance has not been studied with Ozempic in a head-to-head trial. Neither have the two drugs been studied when given in combination.

However, Ozempic in a dose of 1 mg has been studied compared to Canagliflozin (Invokana) 300 mg per day orally. The A1C lowering effects of Ozempic 1 mg and Invokana 300 mg were -1.5% and 1% respectively.

Similarly, in terms of weight loss, Ozempic in a dose of 1 mg resulted in a weight loss of 5.3 kgs vs 4.2 kgs with Canagliflozin.

Jardiance and Ozempic together can enhance each others’ weight loss and glycemic effects:

The combination of Jardiance and Ozempic together may have an additive effect on body weight and blood glucose levels.

Although it is not very straightforward to add the efficacies of the two drugs if given in combination, the result can be very close if Jardiance and Ozempic are used together.

Here is a theoretical calculation of the combination of both these drugs when given as monotherapy and in combination:

Jardiance and Ozempic together may reduce the incidence of UTIs and genital yeast infections:

Unlike metformin, Jardiance does not have gastrointestinal side effects. Thus if the two drugs are given in combination, the incidence of gastrointestinal side effects does not increase.

In addition, one of the most common side effects of Jardiance is UTIs and genital yeast infections.

However, these side effects are more common in people who have uncontrolled blood glucose and a significant amount of glucose is excreted in the urine while using Jardiance.

When Jardiance and Ozempic are combined, it is logical that the blood glucose will go down, and hence the little amount of glucose is going to get excreted in the urine.

Thus, the incidence of urinary tract infections and genital yeast infections will definitely decrease.

Jardiance and Ozempic may improve cardiovascular outcomes:

In addition, both Jardiance and Ozempic are considered heart-friendly medicines. The combination of these drugs may markedly improve cardiovascular health.

Hence, lower rates of cardiovascular deaths and hospitalizations due to heart failure are expected.

The cardiac benefits can be the result of improved blood glucose, reduced body weight, reduction in fluid overload, and direct cardiac effects.

Cons of Using Jardiance and Ozempic Together:

We know both drugs do not interact with each other. Hence, very few side effects are expected if Jardiance and Ozempic are combined together.

The risk of hypoglycemia is minimal as both drugs have little effect on insulin secretion if the blood glucose is within the normal range.

Jardiance and Ozempic may increase the incidence of renal failure:

Jardiance is associated with dehydration and volume depletion and so is Ozempic. Jardiance increases glucose excretion in the urine by inhibiting its re-absorption.

The glucose acts as osmotically active particles and draws in water with it resulting in water excretion via urine.

Ozempic is associated with significant gastrointestinal side effects. Nausea, vomiting, reduced intake of fluids, constipation, and diarrhea can all lead to dehydration.

Thus, the combination of Jardiance and Ozempic may put the patient at an increased risk of dehydration and ultimately renal failure.

Jardiance and Ozempic together may worsen preexisting diabetic eye disease:

Jardiance causes dehydration of the lens and cornea. Dry eyes and dry oral cavities are commonly reported by patients who are on Jardiance.

Ozempic on the other hand has been associated with worsening preexisting diabetic retinopathy.

The combination of Jardiance and Ozempic may result in blurred vision and complicate preexisting diabetic eye disease.

In Summary:

Jardiance is an acceptable combination, rather a preferred drug to combine with Ozmepic, Rybelsus, or Mounjaro.

It helps better control your blood glucose and lets you lose more weight at a faster rate than taking Ozempic or Mounjaro alone.

The table below summarizes the Pros and Cons of using Jardiance and Ozempic together.