What is Empagliflozin (Sodium-Glucose Cotransporter 2 inhibitor)?

From the Guidelines

Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that should be used to treat type 2 diabetes mellitus, particularly in patients with established cardiovascular disease or at high risk for cardiovascular events, due to its ability to reduce the risk of heart failure hospitalizations and cardiovascular death, as demonstrated in the EMPA-REG OUTCOME trial 1.

Key Points

• Empagliflozin works by preventing the kidneys from reabsorbing glucose back into the bloodstream, causing excess glucose to be eliminated through urine, which helps lower blood sugar levels.
• It is typically prescribed under the brand name Jardiance, usually taken once daily at a dose of 10 mg or 25 mg.
• Beyond its glucose-lowering effects, empagliflozin has shown significant cardiovascular benefits, including reducing the risk of heart failure hospitalizations and cardiovascular death in patients with heart disease, as well as offering renal protection by slowing kidney function decline in patients with chronic kidney disease 1.
• Common side effects include genital yeast infections, urinary tract infections, and increased urination, and patients should maintain adequate hydration while taking this medication and be aware of rare but serious side effects like diabetic ketoacidosis 1.
• The most recent guidelines recommend the use of SGLT2 inhibitors, including empagliflozin, in patients with type 2 diabetes and increased cardiovascular risk or established cardiovascular disease to prevent the development of incident heart failure 1.

Dosage and Administration

• The recommended dose of empagliflozin is 10 mg once daily, with the option to increase to 25 mg once daily for additional glucose-lowering effects if needed, as supported by the study 1.

Special Considerations

• Empagliflozin is contraindicated in patients with severe renal impairment (eGFR < 30 mL/min/1.73 m2) or end-stage renal disease, and its use should be cautious in patients with renal insufficiency (eGFR < 45 mL/min/1.73 m2) 1.

From the FDA Drug Label

12 CLINICAL PHARMACOLOGY

1. 1 Mechanism of Action Sodium-glucose co-transporter 2 (SGLT2) is the predominant transporter responsible for reabsorption of glucose from the glomerular filtrate back into the circulation. Empagliflozin is an inhibitor of SGLT2 By inhibiting SGLT2, empagliflozin reduces renal reabsorption of filtered glucose and lowers the renal threshold for glucose, and thereby increases urinary glucose excretion.

Empagliflozin is a Sodium-Glucose Cotransporter 2 (SGLT2) inhibitor. It works by inhibiting SGLT2, which reduces renal reabsorption of filtered glucose and increases urinary glucose excretion. Key points about empagliflozin include:

• Mechanism of action: Inhibition of SGLT2
• Effect on glucose: Reduces renal reabsorption of filtered glucose and increases urinary glucose excretion
• Use: For the treatment of type 2 diabetes 2

From the Research

What is Empagliflozin

• Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used for the treatment of type 2 diabetes mellitus (T2DM) 3, 4, 5.
• It works by inhibiting the reabsorption of glucose in the kidneys, leading to increased urinary glucose excretion and improved glycemic control 4, 5, 6.
• Empagliflozin has been shown to have a favorable safety profile, with a low risk of hypoglycemia and no increased risk of weight gain 3, 5.

Mechanism of Action

• Empagliflozin selectively inhibits SGLT2, reducing glucose reabsorption in the kidneys and increasing urinary glucose excretion 4, 6.
• This mechanism of action is independent of insulin, making it a unique treatment option for T2DM 5, 6.
• Empagliflozin has also been shown to have beneficial effects on weight, blood pressure, and cardiovascular risk 3, 4, 7.

Clinical Use

• Empagliflozin is used as an adjunct to diet and exercise to improve glycemic control in adults with T2DM 3, 4, 5.
• It can be used as monotherapy or in combination with other antidiabetic agents, including metformin and insulin 3, 5.
• Empagliflozin has been shown to be effective in reducing cardiovascular risk and improving renal function in patients with T2DM and cardiovascular disease 4, 7.

Safety and Tolerability

• Empagliflozin has been generally well tolerated in clinical trials, with a similar safety profile to placebo 3, 5.
• Common adverse events include genital mycotic infections, urinary tract infections, and events related to volume depletion 3, 4, 5.
• Empagliflozin has a low potential for organ toxicity, mutagenicity, or carcinogenicity 4.