Home Drug Guide Empagliflozin

Drug Guide

Generic Name

Empagliflozin

Brand Names Jardiance

Classification

Therapeutic: Antidiabetic agent

Pharmacological: SGLT2 inhibitor

FDA Approved Indications

Type 2 diabetes mellitus to improve glycemic control
Reduction of cardiovascular death in adults with established cardiovascular disease and type 2 diabetes

Mechanism of Action

Empagliflozin inhibits the sodium-glucose co-transporter 2 (SGLT2) in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion, thereby lowering blood glucose levels.

Dosage and Administration

Adult: Start at 10 mg once daily, with or without food. May increase to 25 mg based on response and tolerability.

Pediatric: Not approved for use in children.

Geriatric: Renal function should be assessed; initial dose may be 10 mg daily.

Renal Impairment: Use caution; dose adjustment may be necessary based on renal function.

Hepatic Impairment: No specific dosage adjustment necessary.

Pharmacokinetics

Absorption: Rapid absorption with peak plasma concentrations in approximately 1.5 hours.

Distribution: Not significantly bound to plasma proteins.

Metabolism: Minimal metabolism; primarily excreted unchanged.

Excretion: Primarily via urine, both as unchanged drug and metabolites.

Half Life: Approximately 12.4 hours.

Contraindications

Severe renal impairment (eGFR < 30 mL/min/1.73 m²)
End-stage renal disease
Patients on dialysis

Precautions

Monitor renal function periodically, especially in volume-depleted or hypotensive patients. Use with caution in hepatic impairment.

Adverse Reactions - Common

Genitourinary infections (e.g., yeast infections, urinary tract infections) (Common)
Hypotension (Common)
Increased urination (Common)

Adverse Reactions - Serious

Ketoacidosis (including euglycemic ketoacidosis) (Serious rare)
Acute kidney injury (Rare)

Drug-Drug Interactions

Diuretics, insulin, insulin secretagogues (risk of hypotension, hypoglycemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose, renal function, blood pressure, signs of genitourinary infections.

Diagnoses:

Risk for infection
Risk for hypotension
Imbalanced nutrition related to hyperglycemia.

Implementation: Administer once daily, monitor labs, educate patient on signs of infection and dehydration.

Evaluation: Assess glycemic control, renal function, and patient adherence.

Patient/Family Teaching

Take medication exactly as prescribed.
Maintain hydration.
Report symptoms of urinary infections, genital infections, or signs of ketoacidosis.
Monitor blood glucose regularly.

Special Considerations

Black Box Warnings:

Risk of ketoacidosis, which can be life-threatening. Patients should be aware of symptoms (nausea, vomiting, abdominal pain, confusion).

Genetic Factors: Not specifically determined.

Lab Test Interference: May cause false reduction in blood glucose measurements by some methods.

Overdose Management

Signs/Symptoms: Dehydration, hypotension, hypoglycemia in combination with other agents.

Treatment: Discontinue empagliflozin, provide supportive care, manage dehydration and hypotension as needed, monitor renal function.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions.