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SGLT2 Inhibitor

Empagliflozin

Brand names: Jardiance

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses 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.

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: EMPA-REG OUTCOME; EMPEROR-HF trials; NICE TA679; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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