From the Guidelines
Empagliflozin 25 mg is strongly recommended for patients with heart failure, particularly those with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF), based on significant clinical evidence from the most recent and highest quality study, EMPEROR-Preserved 1. The standard dosage is 25 mg taken once daily, which can be administered with or without food.
- Multiple landmark studies, including EMPEROR-Reduced and EMPEROR-Preserved, have demonstrated that empagliflozin reduces cardiovascular death and heart failure hospitalizations by approximately 21-25% 1.
- The medication works through multiple mechanisms, including promoting glucose excretion through the kidneys, reducing cardiac preload and afterload, improving cardiac metabolism, and providing anti-inflammatory effects.
- When initiating empagliflozin, patients should be monitored for potential side effects such as genital mycotic infections, urinary tract infections, and volume depletion, especially during the first few weeks of treatment.
- Patients with type 1 diabetes should not use this medication due to risk of diabetic ketoacidosis.
- Importantly, empagliflozin provides cardiovascular benefits independent of its glucose-lowering effects, making it valuable for heart failure patients regardless of diabetes status.
- Renal function should be assessed before starting treatment, though the medication has shown renal protective effects in clinical trials 1. Some key points to consider when prescribing empagliflozin for heart failure include:
- The medication has been shown to reduce the risk of hospitalization for heart failure and cardiovascular death in patients with HFrEF and HFpEF 1.
- The benefits of empagliflozin are consistent regardless of the presence or absence of type 2 diabetes 1.
- Empagliflozin can be used in combination with other heart failure medications, including ACE inhibitors, ARBs, ARNIs, and beta blockers 1.
From the Research
Effect of Empagliflozin on Heart Failure
The effect of Empagliflozin on heart failure has been studied in several trials.
- Empagliflozin has been shown to reduce the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure with reduced ejection fraction 2.
- The benefit of empagliflozin on heart failure hospitalization, renal composite end point, estimated glomerular filtration slope changes, and health status scores were consistent in both ischemic and nonischemic cause groups without treatment by cause modification 2.
- In patients with heart failure with preserved ejection fraction, empagliflozin reduced the combined risk of cardiovascular death, hospitalization for heart failure, or an emergency or urgent heart failure visit requiring intravenous treatment 3, 4.
- Empagliflozin also reduced the total number of heart failure hospitalizations that required intensive care and the total number of all hospitalizations that required a vasopressor or positive inotropic drug 3.
- The overall evidence shows that empagliflozin can help people with heart failure whether it is caused by reduced ejection fraction or preserved ejection fraction 4, 5.
Dosage and Administration
- The dosage of empagliflozin used in the studies was 10 mg once daily 2, 3, 4, 6.
- However, the question specifically asks about the effect of Empagliflozin 25 milligrams on heart failure, but the studies provided do not mention this specific dosage.
- Empagliflozin is a once-daily medication with minimal drug-drug interactions and does not require titration 5.
Mechanism of Action
- Empagliflozin acts as an enabler for other heart failure drugs by reducing the risk of hyperkalemia 5.
- Empagliflozin is also beneficial for chronic kidney disease which exists commonly with heart failure 5.
- The exact mechanism of action of empagliflozin in reducing the risk of heart failure is not fully understood, but it is thought to be related to its inhibition of the sodium-glucose co-transporter 2 (SGLT2) 6.