Approved Hospital Formulary
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Approved Hospital Formulary
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empagliflozin

empagliflozin
Drug Name Form Strength Notes
Jardiance TABLET, ORAL 12.5 mg (1/2 of a 25 mg tablet) formulary with restrictions for adults. Pediatrics may use 10 mg tablets (or 1/2 tablet - 5 mg)


Additional Information:

Formulary Restricted to patients with a diagnosis of heart failure. Exception Unity to support use for DM without HF. 

For new starts - The provider or their designee, please check coverage and affordability, by sending a discharge prescription to outpatient pharmacy, in order to ensure continuity of care.

Non-Formulary SGLT2-inhibitors, including empagliflozin 25 mg dose, interchange to empagliflozin 12.5 mg for adults.  See Therapeutic Interchange.  

Note: for pediatrics, use of 10 mg tablets may continue with the half tablet option (5 mg).


Last updated: Jul. 7, 2026







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