From the Guidelines
You should temporarily stop empagliflozin with any significant infection, not just UTIs, to minimize the risk of euglycemic diabetic ketoacidosis and other complications. If you develop any infection with symptoms like fever, feeling unwell, or dehydration, pause your empagliflozin and contact your healthcare provider immediately. This is particularly important for urinary tract infections, genital infections, and any infection causing reduced food or fluid intake. Empagliflozin, an SGLT2 inhibitor, works by increasing glucose excretion through urine, which can potentially worsen infections and increase the risk of a serious condition called euglycemic diabetic ketoacidosis (DKA) during illness, as noted in the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1. This risk is higher when you're not eating or drinking normally. You can usually restart empagliflozin once the infection has resolved and you're eating and drinking normally again, but always confirm with your healthcare provider before restarting. Some key points to consider when taking empagliflozin include:
- Monitoring your blood glucose levels more frequently during any illness
- Staying well-hydrated to minimize the risk of volume depletion and hypotension
- Being aware of the potential for mycotic genital infections and seeking prompt medical attention if symptoms occur
- Understanding that empagliflozin may contribute to volume depletion, and adjusting diuretic doses as needed, as suggested in the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1. Remember, the most recent and highest quality study, the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1, provides guidance on the use of SGLT2 inhibitors, including empagliflozin, in patients with heart failure and highlights the importance of careful monitoring and management to minimize the risk of complications.
From the Research
Empagliflozin and Infection Risk
- The decision to discontinue empagliflozin due to infection risk is primarily related to urinary tract infections (UTIs) rather than all types of infections 2, 3, 4, 5.
- Studies have shown that empagliflozin, like other SGLT2 inhibitors, may increase the risk of UTIs, but this risk is generally considered manageable with standard antimicrobial treatment 3, 4, 5.
- The incidence of UTIs with empagliflozin is similar to that of placebo in some studies, suggesting that the overall risk may not be significantly elevated 4, 5.
- Genital infections are also more common with empagliflozin compared to placebo, but the absolute risk remains relatively low 4, 5, 6.
Discontinuation Criteria
- There is no clear evidence to suggest that empagliflozin should be discontinued with any infection, but rather that the decision to discontinue should be based on the severity and type of infection, as well as individual patient factors 2, 4, 5.
- Patients with a history of UTIs or those with underlying conditions that may increase the risk of UTIs (e.g., bladder outlet obstruction) may require closer monitoring while taking empagliflozin 2, 3.
- Discontinuation of empagliflozin due to infection should be considered on a case-by-case basis, taking into account the potential benefits and risks of continued treatment 4, 5.