Short answer: The labels say so, if possible. Jardiance, Farxiga and Invokana each tell prescribers to withhold the drug for at least 3 days before surgery or procedures with prolonged fasting, and to restart once the patient is clinically stable and eating and drinking again. The reason is ketoacidosis, which surgery and fasting can trigger and which can happen with blood sugar below 250 mg/dL.
The dosing section of each label carries the same instruction. Jardiance section 2.3, "Temporary Interruption for Surgery," says to withhold Jardiance for at least 3 days, if possible, before surgery or procedures associated with prolonged fasting, and to resume when the patient is clinically stable and has resumed oral intake. Farxiga (section 2.4) and Invokana (section 2.5) say the same: withhold for at least 3 days, if possible.
The labels address this to the prescriber. The decision about when to stop and restart is made by the prescriber and the surgical team, who know the procedure and the reason the medicine is used.
Section 5.1 of the Jardiance label lists the conditions that can set off diabetic ketoacidosis or other ketoacidosis on an SGLT2 medicine: lower or missed insulin doses, acute illness with fever, eating fewer calories, a ketogenic diet, surgery, volume depletion and alcohol abuse. Fasting before and after an operation touches several of these at once.
The label says fatal ketoacidosis has been reported in people with type 2 diabetes on SGLT2 inhibitors, including Jardiance, and that type 2 diabetes and pancreatic problems such as past pancreatitis or pancreatic surgery are risk factors. Jardiance is not approved for blood sugar control in type 1 diabetes, where the label says the risk is markedly increased.
The Jardiance label says blood sugar at presentation may be lower than usually expected for diabetic ketoacidosis, for example under 250 mg/dL. That is why it tells prescribers to check for ketoacidosis in anyone with signs of severe metabolic acidosis, whatever the glucose reading.
| Point | What the label says |
|---|---|
| Signs and symptoms | Nausea, vomiting, abdominal pain, generally feeling unwell, shortness of breath |
| Blood sugar | May be below what is typical for diabetic ketoacidosis, such as under 250 mg/dL |
| How long sugar stays in the urine | About 3 days after stopping Jardiance (section 12.2) |
| Postmarketing reports | Ketoacidosis or sugar in the urine lasting more than 6 days, some up to 2 weeks after stopping |
| Ketone checks | Consider in type 1 diabetes and in others at risk, if the situation calls for it |
Beyond surgery, the Jardiance label says to withhold the drug, if possible, in temporary clinical situations that could make ketoacidosis more likely, and to resume when the patient is stable and eating and drinking. It tells patients to stop the medicine and get medical help right away if ketoacidosis symptoms appear.
Things worth having ready for a pre-surgery visit: the name and dose of each diabetes medicine, the date of the last dose, and any insulin changes planned for the fasting period. Dose Track can log the last dose before a procedure and remind you when your prescriber says to restart.
Read more on Dose Track: Jardiance side effects · Farxiga side effects · Invokana side effects · Diabetic ketoacidosis (glossary) · Missed a dose of Jardiance · Jardiance vs Farxiga