Empagliflozin
A once-daily SGLT2 inhibitor (gliflozin) for type 2 diabetes, chronic kidney disease and heart failure.
Drug card
- Class
- SGLT2 inhibitor
- How it works
- Blocking glucose reabsorption in the kidney, so glucose leaves in the urine
- Used for
- Type 2 diabetes (adults and children aged 10 and over)
- Heart failure
- Chronic kidney disease
- Cutting cardiovascular death in diabetes with heart disease
- Known for
- Genital yeast infections (thrush)
- Ketoacidosis, even with near-normal glucose
- Its name
- -gliflozin means an SGLT2 inhibitor (gliflozin)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does empagliflozin work?
Empagliflozin is a selective, competitive inhibitor of SGLT2 in the proximal tubule. Less filtered glucose is reabsorbed, so glucose is lost in the urine and blood glucose falls without relying on insulin. It also cuts sodium reabsorption, which lowers cardiac preload and afterload and damps sympathetic activity.
Like other SGLT2 inhibitors: SGLT2 inhibitors block sodium-glucose cotransporter 2 in the proximal tubule, which normally reabsorbs about 90% of filtered glucose. Glucose and sodium pass into the urine, lowering blood glucose without relying on insulin and causing a mild osmotic diuresis. More sodium reaching the distal tubule lowers preload, afterload and glomerular pressure, which may explain their heart and kidney benefits.
Uses
What is empagliflozin used for?
- Type 2 diabetes (adults and children aged 10 and over)
- Heart failure
- Chronic kidney disease
- Cutting cardiovascular death in diabetes with heart disease
Side effects
Side effects of empagliflozin
- Genital yeast infections (thrush)Known for
- Ketoacidosis, even with near-normal glucoseKnown forSerious
- Urinary tract infections, including urosepsisSerious
- Fournier's gangrene (perineal necrotizing fasciitis)Serious
- Dehydration and low blood pressure
- Passing more urine and thirst
- Acute kidney injurySerious
- Higher LDL cholesterol
- Hypoglycemia with insulin or a sulfonylurea
- Swelling of face and throat (angioedema)Serious
- Rash and itching
- Constipation
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Not for glucose control in type 1 diabetes, where it markedly raises the risk of ketoacidosis.
- Stop it before surgery and in acute illness; assess for ketoacidosis whatever the glucose level.
- Check the feet for ulcers and infection: some SGLT2 inhibitor studies showed more lower-limb amputations.
- Not advised for glucose control when eGFR is below 30, where it is unlikely to work.
Good to know: Its benefit in heart failure and kidney disease holds with or without diabetes, so it is also a heart and kidney drug.
Remember it
A way to remember it
Gliflozins make you pee sugar.
Blocking SGLT2 sends glucose into the urine. Follow the sugar: genital yeast infections and UTIs; follow the water it pulls out: dehydration; and watch for ketoacidosis while glucose still looks near normal.
Written for biofideX
Its name
-gliflozin means SGLT2 inhibitor (gliflozin)
WHO defines it as sodium-glucose cotransporter inhibitors related to phlorizin. Empagliflozin and dapagliflozin block SGLT2 in the kidney, so more glucose leaves in the urine.
- Every drug name stem
Its class
SGLT2 inhibitors
Other SGLT2 inhibitors with a card:
Easily mixed up with DPP-4 inhibitors and sulfonylureas.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Empagliflozin tablets: label (DailyMed)
- About empagliflozin (NHS)
- Side effects of empagliflozin (NHS)
- Empagliflozin (NCI Thesaurus)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Diabetes
Empagliflozin is one of 14 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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