SGLT2 inhibitor
Empagliflozin
Blocks sodium-glucose co-transporter 2 in the proximal tubule, producing glycosuria, natriuresis and osmotic diuresis; cardiorenal benefit is largely independent of glucose lowering.
Brands
Jardiance
Adult dosing
Maximum 25 mg/day| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Type 2 diabetes | 10 mgMax 25 mg once daily | Oral | Once daily in the morning |
| Heart failure (any ejection fraction) | 10 mgNo titration needed — 10 mg is the target dose | Oral | Once daily |
| Chronic kidney disease with albuminuria | 10 mg | Oral | Once daily |
Older adults: No dose change; review volume status and antihypertensives because of the diuretic effect.
Paediatric dosing
Always confirm the weight and the local paediatric formulary| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Type 2 diabetes, 10 years and older (specialist) | 10 mgMax 25 mg once daily | Oral | Once daily |
| Under 10 years | Not recommended | — | — |
Renal adjustment
Move the slider to the patient's eGFR10-25 mg once daily
- eGFR ≥ 4510-25 mg once daily
- eGFR 20-4410 mg once daily
- eGFR < 20Do not initiate; specialist decision to continue
- DialysisNot indicated
Hepatic adjustment
- Mild to moderateNo adjustment
- SevereAvoid — limited data
Practical notes
The things that go wrong at the bedside- Expect an eGFR dip of up to 10% in the first weeks — this is haemodynamic and not a reason to stop.
- Withhold for 3 days before major surgery or during any illness with poor oral intake (euglycaemic ketoacidosis risk).
- Review loop diuretic dose when starting in heart failure to avoid over-diuresis.
DrZep structured dosing table (demo dataset, formulary-aligned) · DrZep. Confirm every dose against your local formulary and the patient's weight, renal function and comorbidities.
Indications
- Type 2 diabetes
- Heart failure across the ejection fraction spectrum (with or without diabetes)
- Chronic kidney disease with albuminuria
- Cardiovascular and renal risk reduction
Dosing summary
- Type 2 diabetes
- 10 mg once daily; may increase to 25 mg
- Heart failure
- 10 mg once daily
- Chronic kidney disease
- 10 mg once daily
Organ adjustment
Renal
- eGFR ≥ 20
- Continue for cardiorenal benefit; glucose-lowering effect declines below 45
- eGFR < 20
- Not usually initiated; specialist decision
- Dialysis
- Not recommended
Hepatic
- Mild-moderate
- No adjustment
- Severe
- Not recommended
Monitoring
- 1eGFR at baseline, after 2-4 weeks (an early dip is expected and acceptable) and periodically
- 2Volume status and blood pressure
- 3Ketones during acute illness
- 4Genital hygiene counselling
Contraindications & cautions
Do not use / use with care
- Type 1 diabetes (unless specialist, given DKA risk)
- Previous SGLT2-inhibitor DKA
- Active severe genitourinary infection
- Pregnancy and breastfeeding
Pregnancy & lactation
- Pregnancy
- Avoid — discontinue and switch before conception or as soon as pregnancy is confirmed.
- Lactation
- Avoid.
Interactions
- Loop diureticsAdditive volume depletion and hypotensionmoderate
- Insulin and sulfonylureasHypoglycaemia — reduce the partner drug dosemoderate
- LithiumAltered lithium levels through natriuresismoderate
Adverse effects
Common
- Genital mycotic infection
- Polyuria
- Volume depletion and postural dizziness
- Urinary tract infection
Serious
- Euglycaemic diabetic ketoacidosis
- Necrotising fasciitis of the perineum (Fournier gangrene, rare)
- Acute kidney injury with volume depletion
- Urosepsis
Toxicity & overdose
Recognise and treat
- Euglycaemic DKA — diagnose on ketones and pH, not glucose; withhold during acute illness, fasting and around surgery (typically 3 days before)
Alternatives
- Dapagliflozin
- GLP-1 receptor agonist
- Sacubitril-valsartan and MRAs in heart failure
- Finerenone in diabetic kidney disease
Linked diseases & guidelines
ADA Standards of Care in Diabetes
Annual standards for diagnosis, glycaemic targets, pharmacologic sequencing and complication screening.
American Diabetes AssociationUSA2025
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Four-pillar therapy for HFrEF, SGLT2 inhibitors across the ejection-fraction spectrum, congestion management.
European Society of CardiologyEurope2023
Demo monograph for educational use. Always confirm dose, route and interactions against your national formulary and the product label before prescribing.
Demo content. Educational decision support only. Verify every dose, citation and recommendation against your national formulary and the primary source before clinical use.