SGLT2 Inhibitor Pregnancy: No data in pregnant women; as a precaution it is preferable to avoid use during pregnancy. Should not be used during breast-feeding.

Empagliflozin

Brand names: Jardiance

Used in: Diabetes & DKA

Empagliflozin is an SGLT2 inhibitor used in type 2 diabetes and, independently of diabetes, in heart failure and chronic kidney disease, with cardiovascular and renal benefits.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg once daily

Route: Oral

Frequency: Once daily

Max: 25 mg daily

Type 2 diabetes mellitus: starting dose 10 mg once daily (monotherapy or add-on); in patients tolerating 10 mg with eGFR >=60 ml/min/1.73 m2 who need tighter glycaemic control, dose may be increased to 25 mg once daily. Heart failure: 10 mg once daily. Chronic kidney disease: 10 mg once daily. When combined with a sulphonylurea or insulin, a lower dose of the sulphonylurea/insulin may be considered to reduce hypoglycaemia risk. Tablets may be taken with or without food, swallowed whole with water. Paediatric (type 2 diabetes): starting dose 10 mg once daily, may increase to 25 mg once daily; no data below 10 years of age or with eGFR <60 ml/min/1.73 m2, and not established for heart failure or CKD under 18 years.

Dose adjustments

Renal

Not recommended to initiate if eGFR <20 ml/min/1.73 m2 (limited experience). Daily dose is 10 mg where eGFR <60 ml/min/1.73 m2. In type 2 diabetes, glucose-lowering efficacy is reduced at eGFR <45 and likely absent at eGFR <30 ml/min/1.73 m2; consider additional glucose-lowering treatment if eGFR falls below 45.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Assess renal function before initiating and as clinically indicated. Assess volume status and correct volume depletion before initiating. ( 2.1 ) Individualize the starting dosage based on the patient's current regimen and renal function. ( 2.2 , 2.3 , 2.4 ) The maximum recommended dosage is 25 mg/day of empagliflozin and 2,000 mg/day of metformin HCl. ( 2.2 , 2.3 ) Initiation of SYNJARDY or SYNJARDY XR is not recommended in patients with an eGFR less than 45 mL/min/1.73 m 2 , due to the metformin HCl component. ( 2.4 ) SYNJARDY: take orally twice daily with meals, with gradual dosage escalation to reduce the gastrointestinal adverse reactions due to metformin HCl. ( 2.2 , 2.3 ) SYNJARDY …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-30. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Genital infections (vaginal moniliasis, vulvovaginitis, balanitis)
Urinary tract infection (including pyelonephritis and urosepsis)
Hypoglycaemia (when used with a sulphonylurea or insulin)
Volume depletion; thirst
Diabetic ketoacidosis (rare); pruritus, rash, urticaria, angioedema

Interactions

Sulphonylureas or insulin: increased risk of hypoglycaemia; consider a lower dose of the sulphonylurea or insulin
Diuretics: additive effect may increase risk of dehydration and hypotension

Clinical monograph

How it works

It blocks the sodium-glucose co-transporter 2 in the proximal renal tubule, increasing urinary glucose and sodium excretion; its cardiorenal benefits are only partly explained by glucose lowering.

Prescribing in practice

There is a risk of diabetic ketoacidosis, which can occur with near-normal glucose — apply sick-day rules (withhold during acute illness, fasting or surgery) and counsel on warning symptoms.
Genital and urinary infections and volume depletion can occur, especially with diuretics; a small early dip in eGFR is expected.
Cardiorenal indications extend to lower eGFR thresholds than the glucose-lowering indication.

Monitoring

Monitor renal function and volume status; remain alert to ketoacidosis symptoms regardless of blood glucose.

Counselling the patient

Follow sick-day rules — stop temporarily if acutely unwell, vomiting or not eating, and seek advice.
Maintain genital hygiene and report symptoms of infection.
Seek urgent help for nausea, vomiting, abdominal pain or breathlessness even if your sugar is normal.

Evidence & guidelines

SGLT2 inhibitors benefit heart failure (EMPEROR programme) and CKD (EMPA-KIDNEY) and type 2 diabetes with cardiovascular risk (EMPA-REG), per NICE guidance.

Reference: EMPEROR-Reduced (Packer et al, NEJM 2020); EMPEROR-Preserved (Anker et al, NEJM 2021); EMPA-REG OUTCOME; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways