Empagliflozin inhibits SGLT2, a protein in the proximal renal tubules responsible for reabsorbing ~90% of filtered glucose. By blocking SGLT2, empagliflozin promotes urinary glucose excretion, reducing blood glucose levels (Lippincott). This mechanism is insulin-independent, making it effective even in advanced diabetes. Additionally, it induces mild osmotic diuresis and modest weight loss.

Empagliflozin also demonstrates cardiovascular benefits, as shown in the EMPA-REG OUTCOME trial, reducing the risk of cardiovascular death in patients with T2DM and established cardiovascular disease (Lange).

1. Type 2 Diabetes Mellitus: First-line or adjunctive therapy to improve glycemic control when diet/exercise and other medications (e.g., metformin) are insufficient (BNF).
2. Heart Failure: Reduces hospitalization risk and mortality in patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetes status.
3. Chronic Kidney Disease (CKD): Slows progression of CKD and reduces cardiovascular risk in patients with albuminuria (BNF).

• Standard Dose: 10 mg or 25 mg once daily, taken in the morning with or without food.
• Renal Impairment:
  • Avoid if eGFR <20 mL/min/1.73m². Efficacy declines at eGFR <45 mL/min/1.73m².
  • Not recommended for glycemic control in CKD stages 4–5 (BNF).
• Hepatic Impairment: No dose adjustment needed.
• Elderly: Monitor for volume depletion and hypotension.

• Genital mycotic infections (e.g., thrush).
• Urinary tract infections (UTIs), polyuria.
• Increased urination, thirst, and transient hypotension.

Serious:

• Euglycemic diabetic ketoacidosis (DKA) – may occur with normal or mildly elevated blood glucose.
• Fournier’s gangrene (rare but life-threatening necrotizing fasciitis).
• Acute kidney injury (risk with dehydration or concomitant NSAIDs).
• Bone fractures (long-term use) and slight LDL cholesterol elevation (Lippincott).

• Contraindications:
  • Type 1 diabetes, diabetic ketoacidosis, severe renal impairment (eGFR <20).
  • Hypersensitivity to SGLT2 inhibitors.

• • Renal function, volume status, HbA1c, and ketones during acute illness or DKA symptoms (nausea, vomiting).
  • Genital hygiene to prevent infections.

Avoid (Category C); not recommended during breastfeeding (BNF).

• Diuretics: Increased risk of dehydration and hypotension.
• Insulin/Sulfonylureas: Higher hypoglycemia risk; consider dose reduction.
• NSAIDs: May exacerbate renal impairment.
• ACE Inhibitors/ARBs: Monitor for hyperkalemia (Lange).

• Generic: Empagliflozin.
• Brand Name: Jardiance®.