Empagliflozin is NOT Recommended for Muscle Loss After Hypertrophy
Empagliflozin should not be used to treat muscle loss after hypertrophy, as there is no evidence supporting this indication and one case report documents empagliflozin-induced myopathy with muscle wasting that resolved upon drug discontinuation. 1
Evidence Against Use for Muscle Loss
Case Report of Empagliflozin-Induced Myopathy
- A 69-year-old man developed muscle pain, weakness, and wasting after starting empagliflozin, with symptoms persisting for one year 1
- Resistance testing confirmed muscle weakness, and symptoms resolved within weeks of stopping empagliflozin 1
- MRI changes reversed after discontinuation, with no other identifiable cause of myopathy found 1
- This represents a temporal relationship between empagliflozin initiation and muscle deterioration 1
Reassuring Data on Muscle Mass Preservation (But Not Treatment)
- In elderly Japanese adults (≥65 years) with type 2 diabetes, empagliflozin 10 mg daily for 52 weeks did not compromise muscle mass or grip strength despite causing weight loss 2
- The placebo-adjusted change in muscle mass was -0.61 kg (95% CI -1.61,0.39), which was not statistically significant 2
- However, this study evaluated prevention of muscle loss during treatment, not treatment of existing muscle loss 2
FDA-Approved Indications for Empagliflozin
Empagliflozin is approved for:
- Glycemic control in type 2 diabetes (adults and children ≥10 years) 3
- Reduction of cardiovascular death and heart failure hospitalization in heart failure with reduced ejection fraction 3, 4
- Cardiovascular risk reduction in adults with type 2 diabetes and established cardiovascular disease 3
None of these indications include treatment of muscle loss or sarcopenia.
Clinical Pitfalls
Key Caution
- Clinicians should maintain high suspicion for drug-induced myopathy when patients on empagliflozin develop muscle symptoms 1
- The temporal relationship between medication initiation and symptom onset is the primary diagnostic indicator 1
- Discontinuation of empagliflozin typically improves symptoms when it is the causative agent 1
Weight Loss Concerns
- Empagliflozin causes significant weight loss (mean -3.26 kg vs -0.90 kg with placebo over 52 weeks) 2
- This weight loss could theoretically worsen pre-existing muscle loss conditions 2
- The weight loss primarily comes from fat mass reduction (-1.84 kg placebo-adjusted) rather than muscle mass 2
Alternative Considerations
If a patient with diabetes has muscle loss after hypertrophy training, focus should be on:
- Optimizing glycemic control with appropriate diabetes medications based on comorbidities 3
- Evaluating for other causes of myopathy (metabolic, inflammatory, endocrine)
- Nutritional assessment and protein intake optimization
- Physical therapy and resistance training program adjustment
Empagliflozin has no role in treating muscle loss and may potentially cause myopathy in susceptible individuals.