Drug reference

Empagliflozin

Sodium-glucose co-transporter 2 (SGLT2) inhibitor · Antidiabetic

Also known as Empagliflozin monohydrate

START

10 mg PO once daily AM (HF/CKD 10 mg); may up-titrate to 25 mg for glycaemia

TYPICAL MAX

25 mg/day

STOP IF

DKA, Fournier gangrene, significant volume depletion/AKI; hold during acute illness/surgery/fasting (sick-day rule)

WATCH

Ketones if unwell (euglycaemic DKA), volume status/renal function, genital/urinary infection, foot care

CDSCO approvedSchedule HATC A10BK03

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1.5h · glucosuria onset
PEAK: 1.5h · Cmax
t½: 12h · plasma t½
DURATION: 1d · once-daily

EXCRETION

UGT glucuronidation; ~41% renal, ~54% faecal

route + CYP

INTERACTIONS

3 major

SEVERE in our sources

PREGNANCY

Avoid in 2nd/3rd trimester (adverse renal development in animals); discontinue when pregnancy recognised

FDA category + note

Top interactionssee all 8 →

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Available in India

15 branded formulations and 5 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Mechanism

Selective SGLT2 inhibition in the proximal renal tubule reducing glucose reabsorption → glucosuria, plus natriuresis, weight/BP reduction and cardiorenal benefits (haemodynamic, metabolic) independent of glucose lowering.

Indications

Type 2 diabetes mellitus (glycaemic control)Heart failure (reduced and preserved EF) — reduce CV death/HF hospitalisationChronic kidney disease (slow progression)Reduce CV death in T2DM with established CVD

Dosing

Adult: 10 mg PO once daily in the morning; may increase to 25 mg for additional glycaemic control. HF/CKD: 10 mg once daily.
Pediatric: ≥10 years T2DM: 10 mg once daily (per label).
Renal adjustment: Glycaemic efficacy declines as eGFR falls; CV/renal benefit retained down to eGFR ~20; do not initiate for glycaemia if eGFR <30 (indication-dependent thresholds).
Hepatic adjustment: No adjustment mild–moderate; severe not studied — caution.
Geriatric: Volume depletion risk; monitor.
Max dose: 25 mg/day

Pharmacokinetics

Onset

Glucosuria within hours; clinical effects over weeks

Peak effect

Cmax ~1.5 h

Duration

~24 h (once daily)

Half-life

~12 h

Bioavailability

Well absorbed (food-independent)

Protein binding

~86%

Metabolism

Glucuronidation (UGT); minimal CYP

Excretion

~54% faecal, ~41% renal (mostly metabolites)

Contraindications

Type 1 diabetes / diabetic ketoacidosis
Dialysis / severe renal impairment for glycaemic indication (efficacy lost)
Hypersensitivity to empagliflozin

Side effects

Common

Genital mycotic infectionsUrinary tract infectionIncreased urination/volume depletionThirstMild LDL increase

Serious

Diabetic ketoacidosis (incl. euglycaemic)
Necrotising fasciitis of perineum (Fournier gangrene, rare)
Volume depletion/AKI, hypotension
Severe UTI/urosepsis
Lower-limb amputation signal (class, agent-variable); hypoglycaemia (with insulin/sulfonylurea)