Formulary
Empagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
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Empagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
Drug action
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
Indications and dose
**Type 2 diabetes mellitus [as monotherapy if metformin inappropriate],Type 2 diabetes mellitus [in combination with insulin or other antidiabetic drugs]**
- **Adult** (By Mouth): 10 mg once daily, increased to 25 mg once daily, dose increased if necessary and if tolerated.
**Symptomatic chronic heart failure,Chronic kidney disease**
- **Adult** (By Mouth): 10 mg once daily.
Cautions
Complicated urinary tract infections-consider temporarily interrupting treatment; elderly; hypotension; risk of volume depletion Cautions, further information Volume depletion Correct hypovolaemia before starting treatment. Consider interrupting treatment if volume depletion occurs. M Elderly Increased risk of volume depletion in patients aged 75 years and older. M
Contraindications
Diabetic ketoacidosis; type 1 diabetes mellitus (increased risk of diabetic ketoacidosis)
Side effects
Common or very common Balanoposthitis; constipation; hypoglycaemia (in combination with insulin or sulfonylurea); hypovolaemia (more common in elderly); increased risk of infection; skin reactions; thirst; urinary disorders; urosepsis Uncommon Angioedema; ketoacidosis (discontinue immediately) Rare or very rare Fournier's gangrene (discontinue and initiate treatment promptly); nephritis tubulointerstitial
Interactions
**Other interactions (24):**
- Pharmacodynamic interactions Insulin and sulphonylureas Insulin and sulphonylureas may increase the risk of hypoglycaemia.
- Therefore, a lower dose of insulin or sulphonylureas may be required to reduce the risk of hypoglycaemia when used in combination with Glyxambi (see sections 4.2, 4.4 and 4.8).
- Diuretics Empagliflozin may add to the diuretic effect of thiazide and loop diuretics and may increase the risk of dehydration and hypotension (see section 4.4).
- Pharmacokinetic interactions Effects of other medicinal products on empagliflozin Empagliflozin is mainly excreted unchanged.
- The effect of UGT induction on empagliflozin (e.g.
- Co-treatment with known inducers of UGT enzymes is not recommended due to a potential risk of decreased efficacy of empagliflozin.
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
Hepatic impairment
Avoid in severe impairment (risk of increased exposure; limited information available). M
Renal impairment
Avoid initiation if eGFR less than 20 mL/minute/1.73 m 2 . M Dose adjustments When used for Type 2 diabetes mellitus: Limit dose to 10 mg once daily if eGFR less than 60 mL/minute/1.73 m 2 . Consider addition of other hypoglycemic agents if eGFR less than 45 mL/minute/1.73 m 2 (reduced efficacy). M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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