Empagliflozin Drug Profile

What is Empagliflozin?

Empagliflozin is a prescription medication belonging to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors. It is primarily used to treat type 2 diabetes mellitus and has additional cardiovascular benefits. This oral medication works by preventing the kidneys from reabsorbing glucose back into the bloodstream, allowing excess sugar to be eliminated through urine.

Uses

Empagliflozin has several approved therapeutic uses:

• Type 2 diabetes management: Used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
• Cardiovascular risk reduction: Reduces the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease
• Heart failure treatment: Reduces the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure
• Chronic kidney disease: Slows the progression of kidney disease in adults with chronic kidney disease at risk of progression
• Combination therapy: Often used alongside other diabetes medications like metformin when single-drug therapy is insufficient

How it works

Empagliflozin blocks SGLT2 receptors in the kidneys, which are responsible for reabsorbing about 90% of filtered glucose back into the bloodstream. By inhibiting these receptors, the medication causes excess glucose to be eliminated through urine, effectively lowering blood sugar levels. This mechanism also leads to modest weight loss and blood pressure reduction due to the loss of calories and fluid through increased urination.

Side effects

Common side effects:

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• Urinary tract infections
• Increased urination
• Thirst
• Genital yeast infections
• Nausea
• Upper respiratory tract infections
• Low blood pressure
• Dehydration

Serious side effects requiring immediate medical attention:

• Diabetic ketoacidosis (even with normal blood sugar levels)
• Serious urinary tract infections that may spread to kidneys
• Necrotizing fasciitis of the perineum (Fournier’s gangrene)
• Severe dehydration leading to kidney injury
• Bone fractures

Warnings and precautions

• Kidney function monitoring: Should be used cautiously in patients with reduced kidney function, and kidney function should be monitored regularly during treatment
• Pregnancy and breastfeeding: Not recommended during pregnancy, especially in the second and third trimesters, as it may harm the developing kidneys; breastfeeding is not recommended while taking this medication
• Diabetic ketoacidosis risk: Patients should be educated about signs and symptoms of ketoacidosis, which can occur even when blood glucose levels are not severely elevated
• Surgery and illness: May need to be temporarily discontinued during periods of illness, surgery, or other stress that could lead to dehydration
• Elderly patients: Increased risk of dehydration and low blood pressure in patients over 65 years of age

Interactions

• Insulin and insulin secretagogues: Increased risk of hypoglycemia when combined with sulfonylureas or insulin; dosage adjustments may be necessary
• Diuretics: Enhanced diuretic effect may lead to dehydration and low blood pressure when combined with thiazide or loop diuretics
• ACE inhibitors and ARBs: Combination may increase risk of kidney problems and low blood pressure
• Lithium: May increase lithium levels in the blood, requiring closer monitoring
• Digoxin: Potential for increased digoxin levels due to kidney function changes
• NSAIDs: May increase risk of kidney injury when used together
• Alcohol: May increase risk of dehydration and low blood sugar
• Herbal supplements: St. John’s wort may affect blood sugar control

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Dosage

For adults with type 2 diabetes, the typical starting dose is 10 mg once daily, taken in the morning with or without food. The dose may be increased to 25 mg once daily if additional glycemic control is needed and the medication is well tolerated. For heart failure or chronic kidney disease, the recommended dose is 10 mg once daily. Dosage adjustments are necessary for patients with moderate to severe kidney impairment. The medication should be discontinued if kidney function falls below certain thresholds. All dosing decisions should be individualized and determined by a healthcare provider based on the patient’s specific condition, kidney function, and response to treatment.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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