What are the contraindications of Empagliflozin (Empagliflozin)

Contraindications of Empagliflozin

Empagliflozin is contraindicated in patients with history of serious hypersensitivity reaction to the drug, severe renal impairment, end-stage renal disease (ESRD), or patients on dialysis. 1

Absolute Contraindications

• History of serious hypersensitivity reaction to empagliflozin or any of its excipients 1
• Severe renal impairment (eGFR <30 mL/min/1.73 m²) 2, 1
• End-stage renal disease (ESRD) 2, 1
• Patients on dialysis 2, 1

Relative Contraindications and Precautions

Renal Function Considerations

• Should not be initiated in patients with eGFR <45 mL/min/1.73 m² for glycemic control 2
• Should be discontinued if eGFR is persistently <45 mL/min/1.73 m² 1
• Glucose-lowering effect is minimal at eGFR <45 mL/min/1.73 m² 2

Volume Status Concerns

• Use with caution in patients at risk for hypotension 1:
  • Elderly patients
  • Patients with low systolic blood pressure
  • Patients on diuretics
  • Patients with renal impairment

Risk of Diabetic Ketoacidosis (DKA)

• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 2, 3
• Use with caution in patients with insulin deficiency 2
• Avoid during critical illness or prolonged fasting 2

Special Populations to Monitor Closely

• Patients with prior amputation 2
• Patients with severe peripheral neuropathy 2
• Patients with severe peripheral vascular disease 2
• Patients with active diabetic foot ulcers or soft tissue infections 2
• Patients at high risk for genital mycotic infections 2

Important Clinical Considerations

• Assessment of renal function is recommended prior to initiation and periodically thereafter 1
• Correct volume depletion prior to initiation 1
• Monitor for signs and symptoms of hypotension after initiating therapy 1
• Consider reducing diuretic dose if patient is on diuretic therapy 3
• Monitor for signs of euglycemic diabetic ketoacidosis, which can occur even with normal blood glucose levels 2
• Be aware that empagliflozin can cause intravascular volume contraction 2, 1

Medication Interactions

• If HbA1c is well-controlled at baseline or patient has history of frequent hypoglycemic events, consider reducing doses of sulfonylureas, glinides, or insulin (by approximately 20%) when starting empagliflozin 2

Despite these contraindications, it's important to note that empagliflozin has demonstrated significant cardiovascular and renal benefits in patients with type 2 diabetes and established cardiovascular disease or chronic kidney disease with eGFR ≥20 mL/min/1.73 m² 2, 4, 5. For patients with heart failure, empagliflozin has shown benefits regardless of baseline diabetes status 6.