Overview
Empagliflozin is an SGLT2 inhibitor indicated to improve glycemic control in type 2 diabetes and reduce cardiovascular and renal risks. It works by increasing urinary glucose excretion and has demonstrated benefits in heart failure and chronic kidney disease. The medication is available as oral tablets and requires monitoring for volume depletion and genitourinary infections.
Mechanism of Action
Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that reduces renal glucose reabsorption, increasing urinary glucose excretion and lowering blood glucose levels. This mechanism also promotes osmotic diuresis and modest natriuresis, contributing to cardiovascular and renal benefits.
Indications
- To reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure
- To reduce the risk of sustained decline in eGFR, end-stage kidney disease, cardiovascular death, and hospitalization in adults with chronic kidney disease at risk of progression
- To reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease
- As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus
Common Doses
- 10 mg
- 25 mg
Dosage
The recommended starting dose is 10 mg once daily in the morning, with or without food. May be increased to 25 mg once daily for additional glycemic control. For heart failure and chronic kidney disease indications, the dose is 10 mg once daily.
Contraindications
- Hypersensitivity to empagliflozin or any excipients in Jardiance
- History of serious hypersensitivity reactions such as angioedema
Side Effects
- Genital mycotic infections
- Urinary tract infections
- Increased urination
- Volume depletion/hypotension
- Hypoglycemia (when used with insulin or sulfonylureas)
- Increased creatinine
- Dyslipidemia
- Nausea
- Increased thirst
Interactions
- Diuretics: Increased risk of volume depletion; monitor volume status and renal function
- Insulin or insulin secretagogues: Increased hypoglycemia risk; may require dose reduction
- Lithium: May decrease serum lithium concentrations; monitor levels more frequently
- Urine glucose tests: SGLT2 inhibitors cause false-positive results; use alternative monitoring methods
- 1,5-anhydroglucitol assay: Unreliable for glycemic monitoring in patients taking SGLT2 inhibitors
Counseling Points
- Take once daily in the morning, with or without food
- Maintain adequate hydration to reduce risk of volume depletion
- Monitor for symptoms of genital or urinary infections and report promptly
- Be aware of increased urination, especially during initial therapy
- Carry glucose source if taking with insulin or sulfonylureas due to hypoglycemia risk
- Do not use urine glucose tests for diabetes monitoring
- Report symptoms of ketoacidosis (nausea, vomiting, abdominal pain, fatigue, difficulty breathing)