Empagliflozin (Heart Failure / CKD)

How it works

It inhibits sodium-glucose co-transporter 2 in the proximal renal tubule, increasing urinary glucose and sodium excretion, which reduces preload, intraglomerular pressure and cardiac and renal stress.

Prescribing in practice

• Counsel on the risk of euglycaemic diabetic ketoacidosis, which can occur with near-normal blood glucose, and advise withholding the drug during acute illness, dehydration or before surgery (sick-day guidance).
• Increased risk of genital mycotic and urinary tract infections, including rare Fournier's gangrene of the perineum.
• An expected small initial dip in renal function and an osmotic diuretic effect mean diuretic co-therapy may need review to avoid volume depletion.

Monitoring

Check renal function before starting and periodically thereafter, and reassess volume status, particularly when used alongside other diuretics.

Counselling the patient

• Stop the medicine and seek urgent advice if you are unwell, vomiting or not eating, and know the symptoms of ketoacidosis even if blood sugar is normal.
• Maintain good genital hygiene and report any genital or perineal pain, swelling or redness promptly.
• This medicine protects your heart and kidneys even if you do not have diabetes.

Evidence & guidelines

The EMPEROR-Reduced, EMPEROR-Preserved and EMPA-KIDNEY trials demonstrated reductions in heart failure hospitalisation and chronic kidney disease progression, supporting NICE recommendations.