From the Guidelines
In patients with gastroenteritis who are taking empagliflozin (Jardiance), the medication should be temporarily discontinued until the acute illness resolves and normal fluid intake is restored, as recommended by the most recent consensus guidelines 1. This approach is based on the potential for empagliflozin to worsen dehydration and electrolyte imbalances, which are common complications of gastroenteritis. The medication works by increasing urinary glucose excretion, which can exacerbate fluid losses and increase the risk of volume depletion and acute kidney injury.
Key considerations for managing empagliflozin in patients with gastroenteritis include:
- Temporarily stopping the medication in the presence of vomiting, diarrhea, or reduced oral intake, and seeking medical attention if symptoms persist or worsen 1
- Monitoring blood glucose levels more frequently during the acute illness, and adjusting glucose-lowering medications as needed 1
- Focusing on maintaining hydration with electrolyte-containing fluids, such as oral rehydration solutions (ORS) 1
- Resuming empagliflozin only when the patient is eating and drinking normally for at least 24 hours, and the acute illness has resolved
It is essential to prioritize the patient's hydration status and electrolyte balance during the acute illness, as the risk of diabetic ketoacidosis may increase during this time, particularly if insulin doses are reduced while SGLT2 inhibitors are continued 1. By temporarily discontinuing empagliflozin and focusing on hydration and electrolyte replacement, healthcare providers can help minimize the risks associated with gastroenteritis in patients taking this medication.
From the FDA Drug Label
Advise patients to seek medical advice immediately if they have reduced oral intake (such as due to acute illness or fasting) or increased fluid losses (such as due to vomiting, diarrhea, or excessive heat exposure), as it may be appropriate to temporarily discontinue JARDIANCE use in those settings [see Warnings and Precautions (5. 3)].
Empagliflozin management in gastroenteritis:
- In patients with gastroenteritis and potential dehydration or electrolyte imbalances, it may be appropriate to temporarily discontinue empagliflozin (Jardiance) use.
- Patients should seek medical advice immediately if they experience reduced oral intake or increased fluid losses due to acute illness, vomiting, diarrhea, or excessive heat exposure.
- The decision to discontinue empagliflozin should be made on a case-by-case basis, considering the individual patient's condition and risk of dehydration or electrolyte imbalances 2.
From the Research
Management of Empagliflozin in Gastroenteritis
- Empagliflozin, a sodium glucose cotransporter-2 (SGLT2) inhibitor, is used to treat type 2 diabetes and has been shown to have cardioprotective and renoprotective properties 3.
- In patients with gastroenteritis, the primary concern is dehydration and electrolyte imbalances, which can be exacerbated by empagliflozin's mechanism of action, including increased urinary excretion of glucose and electrolytes 4.
- There is no direct evidence on the management of empagliflozin in patients with gastroenteritis, but general principles of managing dehydration and electrolyte imbalances should be followed 5, 6.
- In critically ill patients, enteral nutrition should be started as soon as possible, and measures should be taken to prevent gastrointestinal complications, such as vomiting and diarrhea 7.
- Empagliflozin may need to be withheld or adjusted in patients with severe dehydration or electrolyte imbalances, but this decision should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
Electrolyte Imbalances and Empagliflozin
- Empagliflozin can affect electrolyte balances, including increases in serum potassium and magnesium concentrations, and changes in urinary excretion of phosphate, calcium, and other electrolytes 4.
- Patients with gastroenteritis may be at increased risk of electrolyte imbalances due to dehydration and diarrhea, and empagliflozin may exacerbate these imbalances.
- Close monitoring of electrolyte levels and renal function is recommended in patients taking empagliflozin, especially in those with gastroenteritis or other conditions that may affect electrolyte balances 3, 4.