Can Empagliflozin (Empagliflozin) cause diarrhea?

Empagliflozin and Diarrhea

Empagliflozin is not significantly associated with diarrhea as an adverse effect. Based on comprehensive clinical guidelines and research evidence, diarrhea is not listed among the common side effects of empagliflozin therapy 1.

Common Adverse Effects of Empagliflozin

• The most frequently reported adverse effects of empagliflozin include genital mycotic infections, urinary tract infections, volume depletion effects, and risk of euglycemic ketoacidosis 1
• Clinical trials evaluating empagliflozin did not report diarrhea as a significant adverse event 1
• Empagliflozin has been shown to be well-tolerated with a safety profile that does not include significant gastrointestinal disturbances 2
• The drug can be used safely until eGFR reaches 45 ml/min/1.73m², with side effects being rare except for genital infections and hypoglycemia risk when combined with sulfonylureas 2

Comparison with Other SGLT Inhibitors

• Unlike empagliflozin (an SGLT2 inhibitor), sotagliflozin (a dual SGLT1/SGLT2 inhibitor) has been specifically associated with diarrhea in clinical trials 1
• The gastrointestinal side effects seen with sotagliflozin are likely due to its SGLT1 inhibition in the intestines, a mechanism not present with empagliflozin 1
• For patients concerned about gastrointestinal side effects, empagliflozin may be a better choice compared to medications known to cause diarrhea 1

Special Populations and Empagliflozin Use

• In a study of children with glycogen storage disease type Ib, empagliflozin actually improved gastrointestinal symptoms including diarrhea and abdominal pain 3
• Another case report demonstrated that empagliflozin treatment led to remission of Crohn disease-like enterocolitis in a child with glycogen storage disease type Ib, with improvement in stool frequency within the first week of treatment 4

Dosage Considerations

• A systematic review and meta-analysis comparing low-dose (10 mg) versus high-dose (25 mg) empagliflozin found no significant differences in drug-related adverse effects between the two dosages 5
• The incidence of adverse events leading to drug discontinuation and serious adverse events was similar between the 10 mg and 25 mg doses 5

Clinical Implications

• When selecting glucose-lowering medications for patients with diabetes who are prone to diarrhea or have irritable bowel syndrome, empagliflozin appears to be a favorable option due to its low association with gastrointestinal side effects 1
• The benefits of empagliflozin in cardiovascular risk reduction can be achieved without significant concern for diarrhea as an adverse effect 1

Monitoring Recommendations

• While monitoring patients on empagliflozin, focus should be directed toward the known adverse effects such as genital infections (particularly in women), urinary tract infections, and potential volume depletion 2, 5
• Patients should be educated about the importance of maintaining adequate hydration while on empagliflozin therapy 1