Empagliflozin, sold under the brand name Jardiance, among others, is an antidiabetic medication used to improve glucose control in people with type2 diabetes. It is not recommended for type 1 diabetes. It is taken by mouth.
Common side effects include hyperventilation, anorexia, abdominal pain, nausea, vomiting, lethargy, mental status changes, hypotension, acute kidney injury, and vaginal yeast infections. Rarer but more serious side effects include a skin infection of the groin called Fournier's gangrene and a form of diabetic ketoacidosis with normal blood sugar levels. Use during pregnancy or breastfeeding is not recommended. Cautiously use empagliflozin with frequent monitoring of renal function in those with significant kidney disease, the use of empagliflozin for merely hyperglycaemia is not currently recommended given the risk of adverse events. The use of empagliflozin in patients with known cardiovascular disease may be beneficial, but risk and benefit ratio need to be considered and initiation of therapy should be individualised. It was also shown to help slow the progression of mild kidney problems.
Empagliflozin is an inhibitor of the sodium glucose co-transporter-2 (SGLT-2), and works by increasing sugar loss in urine.
Empagliflozin was approved for medical use in the United States and in the European Union in 2014. It is on the World Health Organization's List of Essential Medicines. In 2020, it was the 102nd most commonly prescribed medication in the United States, with more than 6million prescriptions. It has received approval as a generic medication from the US Food and Drug Administration (FDA).
Medical uses
Empagliflozin is indicated in adults with heart failure (both reduced and preserved ejection fraction) to reduce the risk of hospitalisation for heart failure and to a lesser extent, cardiovascular death; in adults with type2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death; and as an adjunct to diet and exercise to improve glycemic control in adults with type2 diabetes.
In June 2023, the US Food and Drug Administration (FDA) expanded the indication, as an addition to diet and exercise, to improve blood sugar control in children 10 years and older with type 2 diabetes.
Contraindications
History of a severe allergic reaction to empagliflozin
End-stage kidney disease
Diabetic ketoacidosis
Side effects
Common
Empagliflozin increases the risk of genital fungal infections. The risk is highest in people with a prior history of genital fungal infections. Empagliflozin has thought to be associated with increased risk of Urinary Tract Infections UTI. Cumulative data from clinical trials have shown comparable risks for developing a UTI between placebo and empagliflozin. Empagliflozin reduces systolic and diastolic blood pressure and can increase the risk of low blood pressure, which can cause fainting and/or falls. The risk is higher in older people, people taking diuretics, and people with reduced kidney function. Slight increases in Low-density lipoprotein (LDL) cholesterol can be seen with empagliflozin, in the range of 2–4% from baseline.