From the Guidelines
Empagliflozin should be used with caution in patients with hyponatremia, as it may worsen the condition, and regular monitoring of serum sodium levels is recommended, especially during the initial weeks of treatment 1. When considering the use of empagliflozin in patients with hyponatremia, it is essential to weigh the potential benefits of the medication against the risks. Empagliflozin has been shown to have significant benefits in reducing the risk of hospitalization for heart failure and cardiovascular death in patients with type 2 diabetes and established heart failure 1. However, the medication can cause osmotic diuresis, leading to volume depletion and electrolyte disturbances, including hyponatremia. Some key points to consider when using empagliflozin in patients with hyponatremia include:
- Regular monitoring of serum sodium levels, especially during the initial weeks of treatment 1
- Close monitoring of patients with pre-existing hyponatremia, elderly patients, those on diuretics, or patients with conditions predisposing to sodium loss 1
- Maintaining adequate hydration, but avoiding excessive water intake in patients with hyponatremia risk 1
- Considering lower doses or alternative medications for patients at risk of hyponatremia 1 The typical starting dose of empagliflozin is 10 mg once daily, which can be increased to 25 mg daily if needed and tolerated 1. However, the dose may need to be adjusted or the medication discontinued if the patient develops hyponatremia while on empagliflozin. It is crucial to prioritize the patient's safety and adjust the treatment plan accordingly, taking into account the potential risks and benefits of empagliflozin in patients with hyponatremia, as the most recent and highest quality study suggests 1.
From the Research
Hyponatremia and Empagliflozin
- Hyponatremia is a common electrolyte disorder that affects approximately 5% of adults and 35% of hospitalized patients, characterized by a serum sodium level of less than 135 mEq/L 2.
- The management of hyponatremia typically involves treating the underlying cause, and clinicians should categorize patients according to their fluid volume status (hypovolemic hyponatremia, euvolemic hyponatremia, or hypervolemic hyponatremia) 2.
- Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been investigated for its effects on cardiovascular clinical outcomes in acute heart failure, and has been shown to promote natriuresis and diuresis, as well as other potentially beneficial cardiovascular effects 3.
- The use of SGLT2 inhibitors, including empagliflozin, in the management of acute heart failure may be beneficial, but requires close monitoring for fluctuations in hemodynamic, fluid, and electrolyte status 3.
- There is no direct evidence in the provided studies on the specific relationship between empagliflozin and hyponatremia, but SGLT2 inhibitors have been shown to have a role in promoting optimized guideline-directed medical therapy and reducing the risk of cardiovascular outcomes in patients with acute heart failure 3.
Treatment and Management
- The treatment of hyponatremia depends on the underlying cause and the severity of symptoms, and may involve the use of urea, vaptans, or hypertonic saline 2, 4.
- International guidelines recommend a cautious approach to correcting severe hyponatremia, with a focus on minimizing the risk of complications such as central pontine myelinolysis 5.
- The European Society of Intensive Care Medicine, the European Society of Endocrinology, and the European Renal Association-European Dialysis and Transplant Association have developed clinical practice guidelines on the diagnostic approach and treatment of hyponatremia, which emphasize the importance of a patient-centered approach and careful monitoring of serum sodium levels 6.