Empagliflozin

Indications

Empagliflozin is used for: Empagliflozin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Adult Dose

Oral Type 2 diabetes mellitus Adult: Initially, 10 mg once daily, may be increased to 25 mg once daily, if necessary.

Child Dose

Renal Dose

CrCl (mL/min) <45 Contraindicated. <60 Max: 10 mg daily.

Administration

May be taken with or without food.

Contra Indications

As treatment for type 1 DM or diabetic ketoacidosis. Renal impairment (CrCl <45 mL/min), ESRD, or patients on haemodialysis. Lactation.

Precautions

Hypotension: Before initiating Empagliflozin, volume status should be assessed and correction on hypovolemia should be made in the elderly, in patients with renal impairment, in patients with low systolic blood pressure and in patients on diuretics since Empagliflozin causes intravascular volume contraction. Impairment in Renal Function: Renal function should be evaluated prior to initiating Empagliflozin and periodically thereafter since Empagliflozin increases serum creatinine and decreases eGFR. Hypoglycemia: In patients taking insulin or an insulin secretagogue with Empagliflozin, a lower dose of insulin or the insulin secretagogue is considered to reduce the risk of hypoglycemia. Genital mycotic infections: Monitoring and treatment should be done if indicated. Urinary Tract Infections: Monitoring and treatment should be done as appropriate. Increased LDL-C: Monitoring and treatment should be initiated if required. Lactation: Discontinue Empagliflozin or discontinue lactation.

Pregnancy-Lactation

Interactions

Additive hypoglycaemic effect if concomitantly used w/ insulin and insulin secretagogues (e.g. sulfonylureas). Increased risk of dehydration and hypotension when used w/ diuretics (e.g. thiazides, loop diuretics).

Adverse Effects

Side effects of Empagliflozin : 1-10% Urinary tract infection (7.6-9.3%) Female genital mycotic infections (5.4-6.4%) Upper respiratory tract infection (3.1-4%) Increased urination (3.2-3.4%) Dyslipidemia (2.3-2.4%) Male genital mycotic infections (1.6-3.1%) Nausea (1.1-2.3%) Polydipsia (1.5-1.7%)

Mechanism of Action

Empagliflozin is a reversible inhibitor of sodium-glucose co-transporter 2 (SGLT2), the main site of filtered glucose re-absorption in the renal proximal convoluted tubules. This reduces re-absorption of filtered glucose and lowers renal threshold for glucose, resulting in increased urinary glucose excretion, thereby reducing blood glucose concentration.