Empagliflozin: Advanced Glycemic Control with Cardiovascular Benefits
| Product dosage: 10 mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $5.12 | $153.68 (0%) | 🛒 Add to cart |
| 60 | $4.91 | $307.37 $294.31 (4%) | 🛒 Add to cart |
| 120 | $4.81
Best per pill | $614.74 $577.57 (6%) | 🛒 Add to cart |
| Product dosage: 25 mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $6.40 | $191.85 (0%) | 🛒 Add to cart |
| 60 | $6.18 | $383.71 $370.65 (3%) | 🛒 Add to cart |
| 120 | $6.09
Best per pill | $767.42 $730.25 (5%) | 🛒 Add to cart |
Synonyms | |||
Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor indicated for the management of type 2 diabetes mellitus. It functions by inhibiting glucose reabsorption in the proximal tubule of the kidney, promoting glucosuria and thereby reducing plasma glucose levels. Beyond its primary glucose-lowering effects, empagliflozin has demonstrated significant cardiovascular and renal protective benefits in large-scale outcome trials. It is an essential therapeutic option within modern treatment algorithms for type 2 diabetes, particularly for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease.
Features
- Active ingredient: Empagliflozin
- Pharmacologic class: Sodium-glucose cotransporter 2 (SGLT2) inhibitor
- Available dosage strengths: 10 mg and 25 mg film-coated tablets
- Administration: Oral, once daily
- Mechanism of action: Selective inhibition of SGLT2 in the proximal renal tubules
- Bioavailability: Approximately 78%
- Half-life: ~12-13 hours
- Time to peak plasma concentration: 1.5 hours
- Primary route of elimination: Hepatic metabolism via UGT2B7, UGT1A3, UGT1A8, and UGT1A9
- Excretion: Urine (54.4%) and feces (41.2%)
Benefits
- Provides effective glycemic control by reducing renal glucose reabsorption and increasing urinary glucose excretion
- Demonstrates significant reduction in major adverse cardiovascular events, including cardiovascular death, in patients with type 2 diabetes and established cardiovascular disease
- Reduces the risk of hospitalization for heart failure in both diabetic and non-diabetic populations
- Shows renal protective effects by slowing the progression of kidney disease and reducing albuminuria
- Promotes modest weight loss and blood pressure reduction through osmotic diuresis and caloric loss
- Lowers the risk of all-cause mortality in high-risk cardiovascular patient populations
Common use
Empagliflozin is primarily indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is increasingly used in patients with type 2 diabetes who have established cardiovascular disease to reduce the risk of cardiovascular death. Additionally, it is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure. It is also approved to reduce the risk of sustained decline in estimated glomerular filtration rate (eGFR), end-stage kidney disease, cardiovascular death, and hospitalization in adults with chronic kidney disease at risk of progression.
Dosage and direction
The recommended starting dose is 10 mg orally once daily, taken in the morning with or without food. Based on glycemic efficacy and tolerability, the dose may be increased to 25 mg once daily. For patients with volume depletion, consider correcting this condition prior to initiation. In patients with chronic kidney disease with eGFR below 20 mL/min/1.73 m², empagliflozin is not recommended. No dosage adjustment is required for patients with hepatic impairment. The tablets should be swallowed whole with water and not chewed, crushed, or split.
Precautions
Monitor renal function before initiation and periodically during treatment. Assess volume status and correct volume depletion before starting therapy. Consider temporary discontinuation during periods of reduced oral intake, such as acute illness or fasting. Monitor for signs and symptoms of urinary tract infections and genital mycotic infections. Regularly assess hydration status, particularly in elderly patients and those on diuretics. Evaluate patients for ketoacidosis risk factors, even in the presence of normal or mildly elevated blood glucose levels. Monitor blood pressure and consider adjustment of antihypertensive medications as needed.
Contraindications
History of serious hypersensitivity reaction to empagliflozin or any product components. Patients with severe renal impairment (eGFR <30 mL/min/1.73 m²), end-stage renal disease, or those on dialysis. Not recommended during the second and third trimesters of pregnancy. Should not be used for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Concomitant use with other SGLT2 inhibitors is contraindicated.
Possible side effects
Common adverse reactions (≥5%) include urinary tract infections, female genital mycotic infections, upper respiratory tract infections, increased urination, and thirst. Less common but serious adverse effects include hypotension, ketoacidosis, acute kidney injury, urosepsis and pyelonephritis, Fournier’s gangrene, bone fractures, and hypersensitivity reactions. Laboratory abnormalities may include increases in serum creatinine, phosphorus, hematocrit, and low-density lipoprotein cholesterol (LDL-C). Cases of necrotizing fasciitis of the perineum (Fournier’s gangrene) have been reported, requiring urgent surgical intervention.
Drug interaction
Diuretics may enhance the risk of volume depletion and hypotension. Insulin and insulin secretagogues may increase the risk of hypoglycemia, requiring dose adjustment. Drugs that reduce glomerular filtration rate or affect renal tubular function may alter empagliflozin efficacy. Inducers of UGT enzymes may decrease empagliflozin concentrations. No clinically significant interactions have been observed with metformin, glimepiride, pioglitazone, sitagliptin, warfarin, verapamil, ramipril, or simvastatin. Monitor patients taking medications that affect volume or electrolyte status.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If the missed dose is not remembered until the next day, the missed dose should be skipped and the regular dosing schedule resumed. Do not take a double dose to make up for a missed dose. Maintain consistent daily dosing to ensure optimal glycemic control and cardiovascular benefits.
Overdose
In the event of overdose, contact poison control or seek emergency medical attention immediately. Symptoms may include severe volume depletion, hypoglycemia (particularly when used with other glucose-lowering agents), and electrolyte abnormalities. Management should include supportive measures focused on correcting volume depletion and electrolyte imbalances. Hemodialysis is unlikely to be effective due to high protein binding (86.2%). Monitor blood glucose, electrolytes, and renal function closely.
Storage
Store at room temperature between 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container to protect from moisture. Keep tightly closed and out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Protect from light and excessive humidity. Do not store in bathroom cabinets where moisture levels may fluctuate.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. The prescribing physician should be aware of the complete medical history and concurrent medications. Individual patient responses may vary, and treatment should be tailored to specific clinical circumstances. Full prescribing information should be reviewed before administration.
Reviews
Clinical trials demonstrate empagliflozin’s robust efficacy in glycemic control with HbA1c reductions of 0.6-0.8% from baseline. The EMPA-REG OUTCOME trial showed a 38% reduction in cardiovascular death and 35% reduction in hospitalization for heart failure. The EMPEROR-Reduced and EMPEROR-Preserved trials confirmed significant benefits in heart failure populations regardless of ejection fraction. EMPA-KIDNEY demonstrated a 28% reduction in kidney disease progression or cardiovascular death in chronic kidney disease patients. Real-world evidence supports the trial findings, showing consistent cardiovascular and renal benefits in diverse patient populations. Healthcare providers report good patient tolerability with the main considerations being genital infections and volume-related effects.