When can empagliflozin (Empagliflozin) be resumed in a patient after endocervical excision?

Resuming Empagliflozin After Endocervical Excision

Empagliflozin should be resumed 48 hours after endocervical excision if there are no complications, with close monitoring for metabolic acidosis. 1

Timing of Medication Resumption

• Endocervical excision is considered a low bleeding risk procedure, allowing for relatively early resumption of medications 1
• For SGLT2 inhibitors like empagliflozin, the following timeline should be followed:
  • Resume empagliflozin 48 hours after the procedure if there are no post-operative complications 1
  • Monitor for signs of euglycemic diabetic ketoacidosis (EDKA) during the first week after resumption 2
• If there were complications during the procedure or evidence of post-procedural bleeding, consider delaying resumption to 72 hours post-procedure 1

Risk Assessment Considerations

• Endocervical excision is typically classified as a low bleeding risk endoscopic procedure 1
• The risk of post-procedural bleeding must be weighed against the cardiovascular benefits of empagliflozin 1, 3
• Factors that may warrant delayed resumption include:
  • Excessive bleeding during the procedure 1
  • Extensive tissue removal or positive margins 4
  • Impaired renal function (eGFR <45 mL/min/1.73m²) 1

Monitoring After Resumption

• After resuming empagliflozin, monitor for:
  • Signs of euglycemic diabetic ketoacidosis (unexplained metabolic acidosis despite normal blood glucose) 2
  • Post-procedural bleeding (which can occur up to 2 weeks after the procedure) 1
  • Adequate wound healing 1

Special Considerations

• If the patient has heart failure with reduced ejection fraction, earlier resumption of empagliflozin (at 24 hours) may be considered due to its significant benefits in reducing heart failure events 3
• For patients with renal impairment:
  • eGFR 30-59 mL/min/1.73m²: Resume at standard dose but with closer monitoring 1
  • eGFR <30 mL/min/1.73m²: Empagliflozin is not recommended 1

Potential Complications to Watch For

• Euglycemic diabetic ketoacidosis is a rare but serious complication of SGLT2 inhibitors that can occur post-surgically 2
• Warning signs include:
  • Unexplained metabolic acidosis
  • Nausea, vomiting, abdominal pain
  • Fatigue or altered mental status
  • Normal or only slightly elevated blood glucose levels

Common Pitfalls to Avoid

• Resuming empagliflozin too early (less than 48 hours) after the procedure, which may increase the risk of metabolic complications 1, 2
• Failing to monitor for signs of EDKA after resumption 2
• Delaying resumption unnecessarily in patients with heart failure, where the medication provides significant cardiovascular benefits 3