Empagliflozin

Sodium-glucose co-transporter 2 inhibitors (SGLT2i)

ATC code: A10BK03

Brand names: Jardiance

Updated 24 Sep 2026 · Methodology

Indications

Chronic kidney disease

First line

Per KDIGO 2024, SGLT2 inhibitors are recommended in CKD with eGFR ≥ 20 mL/min/1.73 m², with or without albuminuria. EMPA-KIDNEY (6,609 patients) showed a 28 % reduction in CKD progression or cardiovascular death. Benefit is similar with or without diabetes. Combined with maximally tolerated ACEi/ARB therapy.

Sources

ICD-10: N18 · ICD-11: GB61

Heart failure

First line

Empagliflozin is one of the four pillars of HFrEF therapy per HF 2021 alongside ACEi/ARNI, beta-blockers, and MRAs. EMPEROR-Reduced (3,730 patients) showed a 25 % reduction in the composite of cardiovascular death or HF hospitalization. EMPEROR-Preserved (5,988 patients) was the first RCT to prove pharmacological benefit in HFpEF: 21 % reduction in the same composite. Diabetes status does not affect the indication.

HFrEF and HFpEF, with or without diabetes.

Sources

ICD-10: I50 · ICD-11: BD10

Type 2 diabetes mellitus

First line

Per 2024 and 2022, empagliflozin and other SGLT2 inhibitors are first-line in T2D patients with established ASCVD, HF (reduced or preserved EF), or CKD. Prescribed independently of and of concurrent metformin therapy. Start 10 mg once daily; titrate to 25 mg if glycemic control is inadequate.

Sources

ICD-10: E11 · ICD-11: 5A11

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Weight loss

Not recommended

International guidelines do not support empagliflozin for weight loss in non-diabetic patients without HF, CKD, or established CVD. The 2–3 kg weight reduction is modest and does not exceed lifestyle change. Drugs approved for obesity are GLP-1 agonists (semaglutide, liraglutide) and tirzepatide. Self-prescription of SGLT2 inhibitors «for weight loss» is unsafe: euglycemic ketoacidosis and genitourinary infections without a metabolic indication are unjustified.

Sources

Eat Weight Disord: Randomized study of the effects of empagliflozin and topiramate dual therapy on anthropometric and metabolic indices in non-diabetic individuals with overweight/obesity on a calorie-restricted diet. (2024)

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Selective reversible inhibitor of SGLT2 in the proximal renal tubules. Reduces glucose and sodium reabsorption, producing glycosuria and mild osmotic diuresis. Lowers by 0.5–1 %, body weight by 2–3 kg, and systolic BP by 4–5 mmHg. Cardioprotective and renoprotective effects extend beyond glucose-lowering and involve hemodynamic, metabolic, and anti-inflammatory mechanisms.

Safety

Contraindications

Hypersensitivity
Type 1 diabetes (ketoacidosis risk)
Severe renal impairment — eGFR below 20 mL/min/1.73 m² in most current labels
Pregnancy and breastfeeding

Serious adverse effects

Euglycemic diabetic ketoacidosis
Fournier gangrene (very rare)
Acute kidney injury (with hypovolemia)
Severe urinary tract infection, pyelonephritis

Common adverse effects

Genitourinary fungal infections (vulvovaginitis, balanitis)
Polyuria, nocturia
Thirst, mild dehydration
Hypoglycemia (only with insulin or sulfonylureas)

Pregnancy: can you take Empagliflozin?

EMA summary of product characteristics (section 4.6): there are no data on empagliflozin use in pregnant women. In animals, empagliflozin crossed the placenta to a very limited extent late in gestation and showed no direct or indirect harmful effects on early embryonic development, but animal studies did show adverse effects on postnatal development. As a precaution, it is preferable to avoid empagliflozin during pregnancy.

Breastfeeding: can you take Empagliflozin?

Breast milk transfer data are limited. The manufacturer label states a contraindication. Choose an alternative in breastfeeding patients.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take once daily in the morning, with or without food. Morning dosing minimizes nocturnal polyuria. Maintain adequate hydration at initiation and during intercurrent illness with dehydration risk — glycosuric diuresis increases the risk of hypovolemia and AKI.

Monitoring

Before starting: eGFR, creatinine, electrolytes, ketones. At 4 weeks and every 6–12 months thereafter: eGFR, creatinine. Temporarily discontinue around surgery, fasting, and severe intercurrent illness — risk of euglycemic diabetic ketoacidosis. Counsel patients with risk factors for fungal infection on urogenital infection signs.

Special situations

Euglycemic diabetic ketoacidosis is rare but life-threatening and occurs at normal glucose levels. Triggers: fasting, low-carb diet, surgery, alcohol, infection. With nausea, vomiting, abdominal pain, or dyspnea, urgently check blood or urine ketones regardless of glucose. Fournier gangrene (necrotizing perineal fasciitis) has been reported as a rare severe complication — with pain, swelling, or erythema in the perineum, stop the drug and seek surgical evaluation immediately.

Drug–drug interactions

2 pairs found. Sorted from critical to minor.

ModerateAmlodipineCalcium channel blockers (dihydropyridines)

Mechanism

SGLT2 inhibitors (empagliflozin) cause osmotic diuresis and mild hypovolaemia. Combined with amlodipine: risk of hypotension and acute kidney injury in dehydration.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.

Management

Standard combination in type 2 diabetes with hypertension. In hypovolaemia (dehydration, vomiting, diarrhoea), temporarily stop empagliflozin. Check blood pressure and creatinine 2 weeks after start.

Sources

ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)

Pair details →Amlodipine →

ModerateBisoprololSelective beta-adrenergic blockers

Mechanism

Empagliflozin (SGLT2 inhibitor) causes osmotic diuresis and mild hypovolaemia. Combined with a beta-blocker: additive orthostatic hypotension risk, especially in the first weeks.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).

Management

The combination is part of guideline-directed therapy in heart failure with reduced ejection fraction and type 2 diabetes. In hypovolaemia (dehydration, vomiting, diarrhoea), temporarily stop empagliflozin. Check blood pressure and creatinine 2 weeks after start.

Sources

Pair details →Bisoprolol →

Label mentions26 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

Majorinsulinclass named in the label
«DRUG INTERACTIONS: Intervention Coadministration of JARDIANCE with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower dosages of the insulin secretagogue or insulin to reduce…»
FDA, section 7 · Open on DailyMed
MajorPhenytoin
«No se ha estudiado el efecto de la inducción de la UGT (p. ej., inducción por rifampicina o por fenitoína) sobre empagliflozina. No se recomienda el tratamiento concomitante con inductores de las…»
AEMPS, section 4.5 · Open on CIMA
MajorRifampicin
«No se ha estudiado el efecto de la inducción de la UGT (p. ej., inducción por rifampicina o por fenitoína) sobre empagliflozina. No se recomienda el tratamiento concomitante con inductores de las…»
AEMPS, section 4.5 · Open on CIMA
Majorsulfonylureasclass named in the label
«DRUG INTERACTIONS: Intervention Coadministration of JARDIANCE with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower dosages of the insulin secretagogue or insulin to reduce…»
FDA, section 7 · Open on DailyMed
ModerateLithium
«Empagliflozina puede aumentar la excreción renal de litio y reducir así los niveles sanguíneos de litio. Se debe monitorizar la concentración sérica de litio con mayor frecuencia después del inicio…»
AEMPS, section 4.5 · Open on CIMA
ModerateLithium
«DRUG INTERACTIONS: Intervention Monitor serum lithium concentration more frequently during JARDIANCE initiation and dosage changes.»
FDA, section 7 · Open on DailyMed
anticonceptivos hormonalesclass named in the label
«Los estudios de interacciones realizados en voluntarios sanos sugieren que empagliflozina no tuvo ningún efecto clínicamente relevante sobre la farmacocinética de metformina, glimepirida…»
AEMPS, section 4.5 · Open on CIMA
Digoxin
«Empagliflozina no inhibe la gp ‑ P a dosis terapéuticas. En base a los estudios in vitro , se considera improbable que empagliflozina provoque interacciones con principios activos que sean sustratos…»
AEMPS, section 4.5 · Open on CIMA
diuréticosclass named in the label
«Diuréticos: Empagliflozina puede aumentar el efecto diurético de las tiazidas y de los diuréticos del asa y puede aumentar el riesgo de deshidratación e hipotensión (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
diuréticos del asaclass named in the label
«Diuréticos: Empagliflozina puede aumentar el efecto diurético de las tiazidas y de los diuréticos del asa y puede aumentar el riesgo de deshidratación e hipotensión (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
diureticsclass named in the label
«DRUG INTERACTIONS: Diuretics»
FDA, section 7 · Open on DailyMed
Gemfibrozil
«Un estudio de interacción con gemfibrozilo, un inhibidor in vitro de los transportadores OAT3 y OATP1B1/1B3, mostró que la C max de empagliflozina aumentaba en un 15 % y el AUC aumentaba en un 59 %…»
AEMPS, section 4.5 · Open on CIMA
Glimepiride
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Hydrochlorothiazide
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Linagliptin
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Metformin
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Pioglitazone
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Ramipril
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Simvastatin
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Sitagliptin
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
sulfonilureasclass named in the label
«Insulina y secretagogos de insulina: La insulina y los secretagogos de insulina, como las sulfonilureas, pueden aumentar el riesgo de hipoglucemia. Por lo tanto, puede necesitarse una dosis más baja…»
AEMPS, section 4.5 · Open on CIMA
tiazidasclass named in the label
«Diuréticos: Empagliflozina puede aumentar el efecto diurético de las tiazidas y de los diuréticos del asa y puede aumentar el riesgo de deshidratación e hipotensión (ver sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
Torasemide
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA
Verapamil
«La exposición a empagliflozina fue similar con y sin la administración conjunta de verapamilo, un inhibidor de la gp ‑ P, lo que indica que la inhibición de la gp ‑ P no tiene un efecto clínicamente…»
AEMPS, section 4.5 · Open on CIMA
Warfarin
«Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

Lithium
«Interacciones que disminuyen los niveles de litio: Empagliflozina»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Empagliflozin used for?

Empagliflozin is evaluated for the following indications with varying evidence strength: Heart failure (evidence tier A), Type 2 diabetes mellitus (evidence tier A), Chronic kidney disease (evidence tier A). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Empagliflozin?

Common side effects of Empagliflozin (≥ 1 in 100): Genitourinary fungal infections (vulvovaginitis, balanitis), Polyuria, nocturia, Thirst, mild dehydration, Hypoglycemia (only with insulin or sulfonylureas). See the Safety section for uncommon and serious reactions.

Is Empagliflozin safe during pregnancy?

Is Empagliflozin compatible with breastfeeding?

Breast milk transfer data are limited. The manufacturer label states a contraindication. Choose an alternative in breastfeeding patients.

Can you drink alcohol while taking Empagliflozin?

Triggers: fasting, low-carb diet, surgery, alcohol, infection.

Who should not take Empagliflozin?

Empagliflozin is contraindicated in: Hypersensitivity; Type 1 diabetes (ketoacidosis risk); Severe renal impairment — eGFR below 20 mL/min/1.73 m² in most current labels; Pregnancy and breastfeeding. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA
EMALabel dated 05/22/2014
FDA / DailyMedLabel dated 08/26/2026

Other drugs in this group

Glibenclamide, Gliclazide, Glimepiride, Insulin, Insulin glulisine, Metformin, Sitagliptin + Metformin, Insulin aspart