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Empagliflozin; Uses, Dosage, Side Effects, Drug Interactions

Empagliflozin is a drug of the gliflozin class, approved for the treatment of type 2 diabetes in adults in 2014. Empagliflozin is a sodium glucose co-transporter-2 (SGLT-2) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adult patients with type 2 diabetes. SGLT2 co-transporters are responsible for reabsorption of glucose from the glomerular filtrate in the kidney. The glucuronic effect resulting from SGLT2 inhibition reduces renal absorption and lowers the renal threshold for glucose, therefore resulting in increased glucose excretion. Additionally, it contributes to reduced hyperglycemia and also assists in weight loss and blood pressure reduction.

Mechanism of Action of Empagliflozin

Empagliflozin is a sodium glucose co-transporter-2 (SGLT-2) inhibitor. SGLT2 co-transporters are responsible for reabsorption of glucose from the glomerular filtrate in the kidney. The glucuronic effect resulting from SGLT2 inhibition reduces renal absorption and lowers the renal threshold for glucose, resulting in increased glucose excretion. Additionally, it contributes to reduced hyperglycemia, assists weight loss, and reduces blood pressure.

Indications of Empagliflozin

Type 2 Diabetes Mellitus
Empagliflozin is indicated as an adjunct to diet and exercise to improve glycemic control in adult patients with type 2 diabetes.
Empagliflozin is primarily used in type 2 diabetics to lower blood glucose levels. Empagliflozin in people with type 2 diabetes reduces the risk of heart attacks and heart failure
An adjunct to diet and exercise to improve glycemic control in adults with Type 2 diabetes mellitus.
To reduce the risk of cardiovascular (CV) death in adult patients with type 2 diabetes mellitus and established CV disease.
indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise
As monotherapy when metformin is considered inappropriate due to intolerance
In addition to other medicinal products for the treatment of diabetes
For study results with respect to combinations, effects on glycaemic control and cardiovascular events,

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Contra-Indications of Empagliflozin

Infection
Low blood sugar
Pituitary hormone deficiency
Decreased function of the adrenal gland
Inadequate vitamin B12
Excess body acid
Extreme loss of body water
The habit of drinking too much alcohol
Alcohol intoxication
Heart attack
Suddenly serious symptoms of heart failure
Liver problems
Recent operation
Fever
Shock
Severe vomiting
Severe diarrhea
Serious lack of oxygen in the blood
Weakened patient
Injury
Sepsis syndrome
X-Ray Study with intravenous iodine contrast agent
Kidney disease with a likely reduction in kidney function
Acute inflammation of the pancreas
Chronic inflammation of the pancreas
Moderate to Severe kidney impairment.

Dosage of Empagliflozin

Strengths: 10 mg; 25 mg

Diabetes Type 2

Initial dose: 10 mg orally once a day in the morning
May increase to 25 mg orally once a day for patients tolerating therapy
Maximum dose: 25 mg per day

Cardiovascular Risk Reduction

Initial dose: 10 mg orally once a day in the morning
May increase to 25 mg orally once a day for patients tolerating therapy
Maximum dose: 25 mg per day

Side Effects of Empagliflozin

Most common

Abdominal or stomach discomfort
increased urination.
low blood pressure,
difficult, burning, or painful urination
discharge with a strong odor from the penis
increased potassium blood levels (hyperkalemia),
low blood sugar (hypoglycemia), and
diarrhea
gas (flatulence)
symptoms of weakness, muscle pain (myalgia)
upper respiratory tract infection
low blood sugar (hypoglycemia)
abdominal pain (GI complaints), lactic acidosis (rare)
low blood levels of vitamin B-12
nausea, vomiting
chest discomfort
chills, dizziness
bloating/abdominal distention
constipation
heartburn

More common

Abdominal or stomach discomfort
cough or hoarseness
decreased appetite
diarrhea
fast or shallow breathing
fever or chills
general feeling of discomfort
lower back or side pain
muscle pain or cramping
painful or difficult urination

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Less common

Abnormal stools
bad, unusual, or unpleasant (after) taste
change in taste
difficulty with moving
discoloration of the fingernails or toenails
flu-like symptoms
joint pain
rash
a runny nose
sneezing
stuffy nose
swollen joints

Drug Interactions of Empagliflozin

Canagliflozin may interact with following drugs, supplements & may decrease the efficacy of the drug

androgens (e.g., methyltestosterone, nandrolone, testosterone)
angiotensin-converting enzyme inhibitors (ACEIs; captopril, ramipril)
angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
angiotensin-converting enzyme inhibitors (ACEIs; captopril, enarapril, ramipril)
antipsychotic medications (e.g., chlorpromazine, haloperidol, olanzapine,
birth control pills
bupropion
atorvastatin
atypical antipsychotics (e.g., aripiprazole, clozapine, olanzapine; quetiapine , risperidone)
“azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
barbiturates (e.g., pentobarbital, phenobarbital)
crizotinib
cyclosporine
lanreotide
levodopa
mifepristone
corticosteroids (e.g., dexamethasone, prednisone)
diabetic drugs (e.g., glyburide, insulin, repaglinide, sitagliptin)
digoxin
diuretics (e.g., furosemide, hydrochlorothiazide)
HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
iodinated contrast material
phenytoin
quinolone antibiotics (e.g., levofloxacin, moxifloxacin)
selective serotonin reuptake inhibitors (SSRIs; citalopram, fluoxetine, sertraline paroxetine,
trimethoprim
teriflunomide
vorinostat
verapamil

Pregnancy & Lactation of Empagliflozin

FDA Pregnancy Category C

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

It is not known if empagliflozin passes into breast milk. If you breastfeeding-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.