Can I continue taking Empagliflozin (Empagliflozin) after surgery?

From the Guidelines

You should discontinue empagliflozin at least 3 to 4 days before a planned surgical procedure. This recommendation is based on the latest guidelines from the American College of Cardiology/American Heart Association, which suggest that SGLT2 inhibitors, such as empagliflozin, should be discontinued 3 to 4 days before surgery to reduce the risk of perioperative metabolic acidosis 1. The decision to restart empagliflozin after surgery should be made in consultation with your healthcare provider, taking into account your specific surgical procedure, recovery progress, kidney function, and overall diabetes management plan.

Some key points to consider when managing empagliflozin in the perioperative period include:

• The risk of dehydration and potentially diabetic ketoacidosis during the perioperative period when fluid intake may be restricted 1
• The stress of surgery can affect blood glucose levels and kidney function, making it essential to monitor these parameters closely 1
• The importance of not restarting empagliflozin on your own without medical guidance, as premature resumption could lead to complications during your recovery period

It is essential to follow the guidance of your healthcare provider and the latest clinical guidelines to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Empagliflozin Use After Surgery

• The decision to continue empagliflozin after surgery depends on various factors, including the patient's medical history, current health status, and the type of surgery performed.
• According to a study published in 2023 2, empagliflozin can be safely used in the inpatient setting, with no significant differences in safety endpoints compared to other oral antihyperglycemic agents.
• However, another study from 2022 3 suggests that high-daily doses of empagliflozin (10,25,50 mg) may have better efficacy than low doses (1,2.5 mg) in patients with type 2 diabetes mellitus, but may also increase the risk of adverse events.

Safety and Efficacy of Empagliflozin

• A review of empagliflozin published in 2018 4 found that it is an effective and generally well-tolerated antihyperglycemic agent, with a low inherent risk of hypoglycemia and a favorable effect on non-glycemic outcomes, including blood pressure and body weight.
• A post hoc analysis of the EMPA-REG OUTCOME trial published in 2019 5 found that empagliflozin reduces the risk of kidney outcomes in patients with or without heart failure, and may slow the progression of chronic kidney disease.
• Another study published in 2023 6 found that empagliflozin is safe and effective in patients with heart failure and preserved ejection fraction, regardless of background diuretic therapy, and may reduce the need for conventional diuretics.

Considerations for Continuing Empagliflozin After Surgery

• Patients should consult their healthcare provider to determine the best course of action for their individual situation.
• The healthcare provider will consider factors such as the patient's medical history, current health status, and the type of surgery performed to make a decision about continuing empagliflozin after surgery.
• It is essential to monitor the patient's condition closely after surgery and adjust their medication regimen as needed to ensure optimal outcomes.