What are the contraindications of Empagliflozin (Empagliflozin)

Contraindications of Empagliflozin

Empagliflozin is absolutely contraindicated in patients with a history of serious hypersensitivity reactions to the medication or any of its excipients, and in patients with severe renal impairment, end-stage renal disease, or those on dialysis. 1

Absolute Contraindications

• Hypersensitivity reactions: History of serious hypersensitivity to empagliflozin or any excipients in the formulation 1
• Severe renal impairment: Patients with eGFR <30 mL/min/1.73 m² 2, 1
• End-stage renal disease (ESRD) 2, 1
• Dialysis patients 2, 1

Relative Contraindications and Cautions

Renal Function Considerations

• Should not be initiated in patients with eGFR <45 mL/min/1.73 m² for glycemic control (minimal glucose-lowering effect at this level) 2
• Should be discontinued if eGFR persistently falls below 45 mL/min/1.73 m² 1

High-Risk Conditions

• Critical illness (avoid use) 2
• Prolonged fasting states (avoid use) 2
• Insulin deficiency (use with caution) 2
• Prior amputation (use with caution) 2
• Severe peripheral neuropathy (use with caution) 2
• Severe peripheral vascular disease (use with caution) 2
• High risk for genital mycotic infections (use with caution) 2

Perioperative Considerations

• Should be discontinued at least 3 days before planned surgery to prevent postoperative ketoacidosis 2

Monitoring Requirements

1. Renal function assessment:

   • Required prior to initiation of empagliflozin
   • Regular monitoring throughout treatment 1

2. Volume status:

   • Assess for volume depletion before starting therapy
   • Correct volume status if indicated to prevent symptomatic hypotension 1
   • Increased monitoring in situations where volume contraction is expected 1

3. Ketoacidosis:

   • Monitor for signs of euglycemic diabetic ketoacidosis, which can occur even with normal blood glucose levels 2
   • Signs include nausea, vomiting, abdominal pain, malaise, and shortness of breath

Important Clinical Considerations

• Empagliflozin is not recommended for patients with type 1 diabetes 1
• Not recommended for treatment of diabetic ketoacidosis 1
• Consider reducing diuretic doses when starting empagliflozin in patients on diuretic therapy 2
• Consider reducing doses of sulfonylureas, glinides, or insulin (by approximately 20%) when starting empagliflozin in patients with well-controlled HbA1c or history of frequent hypoglycemia 2

Despite these contraindications, it's worth noting that empagliflozin has demonstrated significant cardiovascular and renal benefits in appropriate patients with type 2 diabetes and established cardiovascular disease or chronic kidney disease with eGFR ≥20 mL/min/1.73 m² 2, 3.