empagliflozin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
empagliflozin: clinical details
Prescribing considerations
- Confirm the licensed indication and age group; empagliflozin is not for treating type 1 diabetes.
- Assess renal function, volume status, blood pressure and ketoacidosis risk factors before initiation.
- Review risks associated with fasting, restricted intake, dehydration, acute illness, alcohol excess, insulin reduction or surgery.
- During hospitalisation for major surgery or acute serious illness, treatment interruption, blood-ketone monitoring and clinical review before restarting are required.
- Consider temporary interruption during significant fluid loss or complicated urinary infection.
Contraindications and cautions
- Formal contraindication: hypersensitivity to empagliflozin or an excipient.
- Do not use to treat type 1 diabetes because of increased ketoacidosis risk.
- Initiation is not recommended at very low eGFR because experience is limited.
- Tablets contain lactose and are unsuitable for specified rare hereditary disorders of galactose handling.
Monitoring
- Check renal function before initiation, periodically thereafter and before adding medicines that may impair renal function.
- Monitor volume status, blood pressure, renal function, haematocrit and electrolytes when clinically indicated, especially during fluid loss.
- For type 2 diabetes, monitor glycaemic response; glucose-lowering effectiveness diminishes as renal function declines.
- Use blood rather than urine ketones during treatment interruption for major surgery or acute serious illness.
- Monitor lithium concentrations more frequently when empagliflozin is started or changed.
Clinical pharmacology
Empagliflozin is a potent, selective and reversible competitive SGLT2 inhibitor. It promotes glucosuria and natriuresis with osmotic diuresis. Its glucose-lowering effect depends on blood glucose and glomerular filtration. Metabolism is mainly by glucuronidation, with little clinically important CYP-mediated interaction potential.
Formulation and product differences
- The selected product consists of immediate-release film-coated tablets for oral use.
- Tablets should be swallowed whole and may be taken with or without food.
- The tablets contain lactose and are essentially sodium-free.
- Fixed-dose combination products have different administration and safety considerations and are not interchangeable without prescribing review.
empagliflozin preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 25 mg
empagliflozin interactions
Tell the prescriber or pharmacist about all prescribed, over-the-counter and herbal products. Important examples include:
Insulin and sulfonylureas, such as gliclazide
The combination increases hypoglycaemia risk, so the other diabetes treatment may require clinical review.
Loop or thiazide diuretics
Their fluid-losing effect may increase dehydration and low-blood-pressure risk.
Blood-pressure-lowering medicines
Dizziness or symptomatic low blood pressure may be more likely, particularly with fluid depletion.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.