Empagliflozin is an SGLT2 inhibitor that reduces renal glucose reabsorption, promoting glycosuria and lowering blood glucose. Has proven cardiovascular and renal benefits.
Also known as: Jardiance
SGLT2 + loop diuretic: severe risk of dehydration and hypotension.
SGLT2 causes glycosuria (~70 g/day), which drags sodium and water by osmosis. Furosemide inhibits the Na-K-2Cl cotransporter in the loop of Henle, blocking sodium reabsorption. The synergistic combination can cause: (1) severe extracellular volume depletion, (2) orthostatic hypotension with syncope risk, (3) dehydration with creatinine elevation, (4) paradoxical hyperkalaemia (from renal hypoperfusion). Strategy: reduce diuretic dose 24-48h before starting SGLT2, monitor daily weight, weekly electrolytes, and standing/supine BP.
SGLT2 + loop diuretic: severe dehydration and hypotension. Additive diuretic effect — osmotic glycosuria + natriuresis. Reduce diuretic and monitor electrolytes.
Both cause diuresis. SGLT2 causes osmotic glycosuria and furosemide inhibits NaCl reabsorption. Additive volume depletion effect.
Weight, electrolytes, blood pressure, GFR
Syncope, severe hypotension, severe dehydration
Reduce diuretic dose. Monitor electrolytes and hydration status. Consider temporarily discontinuing diuretic.
DailyMed/FDA (NIH/NLM) — approved Empagliflozin (Jardiance) label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8b6261f6-4bdc-462e-8af1-4064664c62f3
No documented food or drink interactions.
Reduced efficacy at low eGFR. Avoid if eGFR <20 mL/min.
Adjust dose according to eGFR. Discontinue if eGFR <20.
DailyMed/FDA (NIH/NLM) — approved Empagliflozin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8b6261f6-4bdc-462e-8af1-4064664c62f3
CONTRAINDICATED in pregnancy. Risk of fetal renal harm (in 2nd and 3rd trimesters).
CONTRAINDICATED in 2nd and 3rd trimesters.
Unknown if excreted in breast milk.
Discontinue at least 3 months before conception.
DailyMed/FDA (NIH/NLM) — approved Empagliflozin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8b6261f6-4bdc-462e-8af1-4064664c62f3
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Selectively inhibits SGLT2 in the proximal convoluted tubule, blocking 80-90% of renal glucose reabsorption.
Blocks SGLT2, preventing glucose transport back into circulation. Glucose is excreted in urine (~70 g/day glycosuria).
Oral bioavailability: 78%. Food does not significantly affect absorption. Tmax: 1.5 hours.
Metabolised by UGT1A3, UGT1A8, UGT1A9 to inactive glucuronide. Does not interfere with CYP. Low interaction potential.
12.4 hours. Elimination: 54% faeces, 36% urine (metabolites).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
