SGLT2 Inhibitor Pregnancy: Avoid

Empagliflozin

Brand names: Jardiance

Adult dose

Dose: 10 mg once daily (HF). 10–25 mg OD (T2DM)

Route: Oral

Frequency: Once daily, morning

Max: 25 mg OD for T2DM; 10 mg OD for HF (HFpEF/HFrEF)

EMPEROR-Reduced (HFrEF) and EMPEROR-Preserved (HFpEF). First SGLT2i licensed for HFpEF. EMPA-REG OUTCOME: CV mortality benefit in T2DM.

Paediatric dose

Route: Oral

Frequency: OD

Max: Not established in children

Not licensed for paediatric use

Dose adjustments

Renal

For HF: can initiate down to eGFR 20. For T2DM: not for glycaemic control if eGFR <45.

Hepatic

No dose adjustment for mild-moderate; caution in severe

Clinical pearls

EMPEROR-Preserved: first trial to show benefit in HFpEF (LVEF >40%) — significant reduction in HF hospitalisation
EMPA-REG OUTCOME: 38% reduction in CV death in T2DM with established CV disease
Sick-day rules apply — suspend with acute illness, dehydration, planned major surgery (3 days before)
Cardiorenal protective effects likely class effect of SGLT2 inhibitors

Contraindications

Type 1 diabetes for HF/CKD indication (euglycaemic DKA risk)
eGFR <20 (initiation for HF)
Dialysis-dependent renal failure

Side effects

Genital mycotic infections
UTI
Euglycaemic DKA
Volume depletion/hypotension
Fournier's gangrene (rare)

Interactions

Diuretics — enhanced diuresis
Insulin/sulfonylureas — hypoglycaemia
NSAIDs — renal impairment risk

Monitoring

eGFR and electrolytes
Signs of DKA
Blood pressure
Weight (osmotic diuresis)

Reference: BNFc; EMPEROR-Reduced (Packer et al, NEJM 2020); EMPEROR-Preserved (Anker et al, NEJM 2021); EMPA-REG OUTCOME; BNF. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

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Pathways