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

Empagliflozin (Elderly HFpEF/HFrEF)

Brand names: Jardiance

This page concerns empagliflozin used for heart failure in older patients, across both reduced and preserved ejection fraction (HFrEF and HFpEF); it is an SGLT2 inhibitor that improves heart-failure outcomes irrespective of diabetes status.

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 (heart failure)

Route: Oral

Frequency: Once daily

Max: 25 mg daily (type 2 diabetes mellitus only; the heart failure and chronic kidney disease dose remains 10 mg once daily)

Heart failure: the recommended dose is 10 mg once daily. Chronic kidney disease: 10 mg once daily. Type 2 diabetes mellitus: starting dose 10 mg once daily for monotherapy and add-on combination; in patients tolerating 10 mg once daily who have an eGFR of 60 ml/min/1.73 m2 or above and need tighter glycaemic control the dose can be increased to 25 mg once daily (maximum daily dose 25 mg). Elderly: no dose adjustment is recommended based on age, but in patients 75 years and older an increased risk of volume depletion should be taken into account. When used with a sulphonylurea or insulin, a lower dose of the sulphonylurea or insulin may be considered to reduce hypoglycaemia risk. Missed dose: take as soon as remembered but do not take a double dose on the same day. Tablets may be taken with or without food, swallowed whole with water. Not for use in type 1 diabetes. Interrupt treatment in patients hospitalised for major surgery or acute serious medical illness and monitor ketones. Hepatic impairment: no dose adjustment required, but not recommended in severe hepatic impairment. Paediatric (type 2 diabetes only, no per-kg dosing stated): starting dose 10 mg once daily, may be increased to 25 mg once daily if tolerated and additional glycaemic control is required; no data below 10 years of age or for eGFR <60 ml/min/1.73 m2, and safety/efficacy in heart failure or chronic kidney disease under 18 years have not been established.

Dose adjustments

Renal

Do not initiate if eGFR is below 20 ml/min/1.73 m2 (limited experience). If eGFR is below 60 ml/min/1.73 m2 the daily dose is 10 mg. In type 2 diabetes, glucose-lowering efficacy is reduced below an eGFR of 45 ml/min/1.73 m2 and likely absent below 30 ml/min/1.73 m2 — consider additional glucose-lowering treatment if needed.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to empagliflozin or to any of the excipients

Side effects

Genital infections (vaginal moniliasis, vulvovaginitis, balanitis)
Urinary tract infection (including pyelonephritis and urosepsis)
Volume depletion
Hypoglycaemia when used with a sulphonylurea or insulin; thirst and constipation
Diabetic ketoacidosis (rare, may be euglycaemic) and, very rarely, necrotising fasciitis of the perineum (Fournier's gangrene)

Interactions

Sulphonylureas or insulin — increased risk of hypoglycaemia; a lower dose of the sulphonylurea or insulin may be considered

Clinical monograph

How it works

It inhibits sodium-glucose co-transporter 2 in the proximal renal tubule, producing glycosuria and natriuresis with osmotic diuresis and favourable cardiac and renal haemodynamic effects.

Prescribing in practice

In frail older heart-failure patients monitor volume status and renal function, as the diuretic effect can cause hypotension and dehydration, and review concurrent loop diuretics to avoid excessive fluid loss.
Counsel on diabetic ketoacidosis risk, which can occur with near-normal glucose, and consider temporary withholding during acute illness, dehydration or before major surgery (sick-day rules).
Genital and urinary infections are more common; advise on hygiene and prompt reporting, and be alert to the rare risk of Fournier's gangrene.

Monitoring

Monitor renal function, blood pressure and volume status after initiation and during intercurrent illness, with an expected small initial dip in renal function that usually stabilises.

Counselling the patient

This medicine helps your heart even if you do not have diabetes; take it once daily as directed.
Stop temporarily and seek advice if you become acutely unwell, dehydrated or stop eating and drinking.
Maintain good genital hygiene and report genital pain, swelling or signs of infection promptly.

Evidence & guidelines

The EMPEROR-Reduced and EMPEROR-Preserved trials demonstrated reductions in heart-failure hospitalisation across the ejection-fraction spectrum, supporting empagliflozin use in older heart-failure patients.

Reference: EMPEROR-Preserved (Anker et al. NEJM 2021); EMPEROR-Reduced (Packer et al. NEJM 2020); NICE NG106 Heart Failure Guidelines; ESC Heart Failure Guidelines 2021; 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.

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