Empagliflozin
SGLT2 inhibitor (Jardiance), Boehringer Ingelheim/Eli Lilly. Cardio-reno-protective drug for T2DM + HFrEF/HFpEF + CKD.
Related comparisons
Metformin vs EmpagliflozinWHAT IS EMPAGLIFLOZIN?
Detailed overview
Empagliflozin is a selective SGLT2 inhibitor (sodium-glucose cotransporter 2) that blocks glucose reabsorption in proximal renal tubule, causing 60-90 g/day urinary glucose loss (glycosuria). FDA-approved for T2DM (2014), HFrEF (EMPEROR-Reduced 2020 PMID 32865377), HFpEF (EMPEROR-Preserved 2021 PMID 34449189), and CKD (EMPA-KIDNEY 2023 PMID 36331190). The EMPA-REG OUTCOME trial (Zinman 2015 NEJM PMID 26378978) was the first MACE-positive SGLT2i trial – showed 38% relative cardiovascular mortality reduction in T2DM + ASCVD.
ATC code
A10BK03
Prescription
Prescription only (Rx)
Mechanism
SGLT2 (sodium-glucose cotransporter 2) inhibitor, proximal renal tubule
Half-life
~12.4 h (once-daily dosing)
Onset
Glucosuria within first dose; HbA1c and blood pressure changes over several weeks
Metabolic support
Glucose and lipid metabolism shift favorably: insulin sensitivity improves, glycemic swings and HbA1c drop, while LDL and triglycerides normalize. Body composition refines, fat mass decreases, lean mass is preserved or grows. Appetite is regulated both centrally and peripherally (GLP-1 / GIP / glucagon pathways), so caloric intake settles into a sustainable range without constant willpower. Energy expenditure and thermogenesis rise modestly.
Data console
Lab data
Research indications
Investigated uses and mechanisms
Weight regulation
Reduced appetite and increased energy expenditure via GLP-1 / GIP / glucagon agonism.
Type 2 diabetes
Improved insulin sensitivity and HbA1c reduction in clinical trials.
Cardiometabolic profile
Favorable shifts in lipid profile and blood pressure.
Safety
Side effects, stop signs, contraindications
Side effects · 8
- Genital fungal infections (vulvovaginitis in women, balanitis in men), the most common side effect (~5-10%), driven by urinary glucose excretion.
- Euglycemic diabetic ketoacidosis (eu-DKA): serious, potentially fatal, and can occur with normal or only mildly elevated blood glucose (even < 250 mg/dL), making it easy to miss; subject of an FDA warning.
- Fournier's gangrene (necrotizing fasciitis of the perineum): rare but life-threatening surgical emergency, carries an FDA warning; genital pain, swelling, redness and fever require immediate care.
- Volume depletion and hypotension: due to osmotic diuresis, especially in the elderly, those with reduced renal function, or on concurrent loop or thiazide diuretics; presents as dizziness and weakness.
- Urinary tract infections (UTI), including rare severe pyelonephritis and urosepsis; glycosuria favors bacterial growth.
- Hypoglycemia: rare on its own, but the risk rises markedly when combined with insulin or a sulfonylurea, often requiring a dose reduction of the companion drug.
- Dehydration and acute kidney injury (AKI): from fluid loss and reduced renal perfusion, with increased risk during intercurrent illness, vomiting or diarrhea.
- Increased urination (polyuria), thirst and a mild rise in LDL cholesterol; mild weight loss is also typical due to osmotic diuresis.
Contraindications · 3
- Severe renal impairment (eGFR < 20 ml/min/1.73 m²)
- Diabetic ketoacidosis history (eu-DKA risk)
- Volume depletion, sepsis
Related Pharmaceuticals
Same therapeutic category
Studies
Related research and clinical findings
Empagliflozin, cardiovascular outcomes, and mortality in T2DM (EMPA-REG OUTCOME)
Zinman B, Wanner C, Lachin JM et al.
Cardiovascular and renal outcomes with empagliflozin in heart failure (EMPEROR-Reduced)
Packer M, Anker SD, Butler J et al.
Empagliflozin in heart failure with a preserved ejection fraction (EMPEROR-Preserved)
Anker SD, Butler J, Filippatos G et al.
Empagliflozin in patients with chronic kidney disease (EMPA-KIDNEY)
EMPA-KIDNEY Collaborative Group.
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The information here is for educational and scientific purposes only. Medication use requires medical consultation and a prescription. The indications, dose ranges, and side effects listed here do NOT replace the official Summary of Product Characteristics (SmPC) or consultation with a physician. Do not start or stop any medication on your own. In an emergency, call your local emergency number.