From the Guidelines
Empagliflozin can be safely initiated in diabetic patients with arrhythmias, with careful monitoring, as it has shown to reduce the risk of major adverse cardiovascular events and cardiovascular death, as evidenced by a 14% reduction in the composite outcome of MI, stroke, and cardiovascular death in a study published in 2022 1. When starting empagliflozin in diabetic patients with arrhythmias, it is essential to:
- Assess the patient's cardiovascular status, renal function (eGFR should be ≥30 mL/min/1.73m²), and volume status
- Check electrolytes, particularly potassium and magnesium, as imbalances could worsen rhythm disturbances
- Monitor for hypotension, especially in patients taking diuretics or antiarrhythmic medications
- Start with the standard dose of 10 mg once daily, taken in the morning, with the option to increase to 25 mg daily if needed and tolerated The medication works by inhibiting sodium-glucose cotransporter-2 in the kidneys, increasing glucose excretion and producing mild diuresis, which may actually benefit some patients with heart failure and arrhythmias. Key considerations include:
- Maintaining adequate hydration
- Reporting symptoms like dizziness, palpitations, or worsening arrhythmia symptoms
- Regularly reviewing the patient's condition and adjusting the treatment plan as necessary, taking into account the latest guidelines on diabetes and cardiovascular diseases, such as those published in 2020 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Starting Empagliflozin in Diabetic Patients with Arrhythmia
- Empagliflozin is a sodium glucose cotransporter-2 (SGLT2) inhibitor that has been shown to be effective in improving glycemic control in patients with type 2 diabetes 2.
- It has also been demonstrated to have cardioprotective and renoprotective properties, making it a valuable treatment option for patients with type 2 diabetes and established cardiovascular disease 2.
- However, there is limited information available on the use of empagliflozin in diabetic patients with arrhythmia.
- A study on the combination of empagliflozin and metformin therapy found that it was effective and well-tolerated in patients with type 2 diabetes, and may be suitable for patients who require treatment with more than one glucose-lowering agent 3.
- Another study discussed the relationship between diabetes and arrhythmias, highlighting the complex and multifactorial nature of this association 4.
- Empagliflozin has been shown to be well-tolerated and effective as add-on therapy to pioglitazone with or without metformin in patients with type 2 diabetes mellitus 5.
- While there is no direct evidence on the use of empagliflozin in diabetic patients with arrhythmia, the available data suggest that it may be a useful treatment option for patients with type 2 diabetes who are at high risk of cardiovascular events 2, 3, 5.
- Cardiac arrhythmias can be diagnosed and treated with various methods, including the use of pacemakers, defibrillators, and antiarrhythmic medications 6.