SGLT2 Inhibitor·Endocrinology - Oral Antidiabetics

Empagliflozin

Type 2 Diabetes, Heart Failure (regardless of ejection fraction), Chronic Kidney Disease

Authority requiredPBSORALJardiance, Jardiamet (combo)10 mg tablet+2

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At a glance

Max Dose

25 mg/day

Half-life

12 h

High risk: Euglycemic DKA

CRITICAL

Caution: Thrush/UTI

HIGH RISK

Cautions

Avoid / Cautions

Type 1 Diabetes (extremely high DKA risk). Pregnancy Category D.

Where it stands

Rapid Summary

Overview

SGLT2 inhibitor. Forces the kidneys to excrete glucose in the urine. Revolutionary drug providing massive mortality benefits in Heart Failure and CKD, independent of its diabetes effect.

Clinical Focus

Can cause life-threatening Diabetic Ketoacidosis (DKA) while the blood glucose appears completely normal (Euglycemic DKA).

Bottom Line

Empagliflozin is an SGLT2 inhibitor with landmark cardiovascular and renal outcome benefits in diabetes and heart failure, but carries risk of euglycaemic DKA, genital mycotic infections, and Fournier's gangrene.

Formulation & Access

Brand Names

Jardiance, Jardiamet (combo)

Oral Routes

Tablets (10 mg, 25 mg).

Prescribing & PBS

Authority Required (PBS) for T2DM, HFrEF, and CKD.

Indications & Use

Primary

PBSTGA

Type 2 Diabetes, Heart Failure (regardless of ejection fraction), Chronic Kidney Disease.

Clinical Place

Standard of care. One of the 'Four Pillars' of heart failure therapy.

Quick reference

Class & Role

SGLT2 Inhibitor — SGLT2 inhibitor.

Route / Formulation

Tablets (10 mg, 25 mg). (Jardiance, Jardiamet (combo))

Usual Dose & Max

PO 10 mg OD. May increase to 25 mg OD. Max 25 mg/day.

Key Indication Doses

Type 2 Diabetes: PO 10 mg OD. May increase to 25 mg OD. Heart Failure (HFrEF/HFpEF) / CKD: PO 10 mg OD (Dose does not need escalating for cardiac/renal benefits). Renal Impairment: Ineffective for glucose lowering if eGFR < 45, but safely continued down to eGFR 20 strictly for cardio/renal protection.

Best Uses

Key Risks

Metabolic: Euglycemic DKA. The patient goes into ketoacidosis from severe insulin starvation, but the blood sugar looks fine because the kidneys are peeing it all out. Genitourinary: Genital mycotic infections (severe thrush), complicated UTIs. CRITICAL — Fournier's gangrene (necrotising fasciitis of the perineum). Cardiovascular: Hypovolemia, orthostatic hypotension (due to osmotic diuresis).

Key Interactions

Additive hypovolemia/hypotension if combined with Loop or Thiazide diuretics.

Monitoring

'Sick Day Rules': Cease immediately if vomiting, fasting, or severely unwell. Check blood ketones (not just BSL) if unwell. Monitor U&E and eGFR.

Clinical Pearl

If a patient on Jardiance presents to ED vomiting and unwell, a normal BSL does NOT rule out DKA. You MUST check a capillary blood ketone level or an ABG. If ketones are > 1.5, treat as DKA.

Access

Authority requiredJardiance, Jardiamet (combo)10 mg tablet

Brand: Jardiance, Jardiamet (combo)
PBS status: Authority required
Formulation: Tablets (10 mg, 25 mg).

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