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SGLT2 Inhibitor Pregnancy: D — avoid

Empagliflozin

Brand names: Jardiance

Adult dose

Dose: 10mg once daily; may increase to 25mg once daily

Route: Oral

Frequency: Once daily in the morning

T2DM: 10mg OD, titrate to 25mg. Heart failure (regardless of diabetes): 10mg OD. Do not initiate if eGFR <20.

Clinical pearls

EMPA-REG OUTCOME: 38% reduction in CV death in T2DM with established CV disease
EMPEROR-Reduced and EMPEROR-Preserved: heart failure benefit with and without diabetes
Hold during acute illness, surgery, fasting for >24h (sick day rules)
Euglycaemic DKA: glucose may be normal — check ketones if unwell
Reduces HbA1c modestly (~0.7%) — primarily used for CV/renal protection

Contraindications

Type 1 diabetes
eGFR <20 mL/min (initiation)
DKA risk factors

Side effects

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

Interactions

Loop diuretics — additive volume depletion
Insulin — DKA risk

Monitoring

HbA1c
eGFR and creatinine (before initiation, then regularly)
Volume status
Urinalysis

Reference: EMPA-REG OUTCOME; EMPEROR-HF trials; NICE TA679. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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