====== Empagliflozin ======

Empagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor used for diabetes, heart failure, and chronic kidney disease.

It was the first SGLT2 inhibitor to demonstrate cardiovascular mortality reduction.

→ [[endocrine:sglt2:start|SGLT2 Inhibitors Overview]]

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===== Mechanism of Action =====

Location:
• Proximal convoluted tubule

Action:
• Blocks SGLT2 transporter
• Increases urinary glucose excretion
• Causes mild natriuresis
• Reduces intraglomerular pressure

Physiologic effects:

• ↓ Blood glucose
• ↓ Preload (mild diuretic effect)
• ↓ Blood pressure
• ↓ Renal hyperfiltration
• Improved cardiac efficiency

Cardiorenal benefits extend beyond glycemic control.

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===== Indications =====

==== Type 2 Diabetes Mellitus ====

• Glycemic control
• Reduces major adverse cardiovascular events
• Promotes modest weight loss

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==== Heart Failure ★ ====

Indicated for:

• HFrEF
• HFpEF

Benefits:

• ↓ HF hospitalization
• ↓ Cardiovascular mortality
• Effective with or without diabetes

Part of the Four Pillars of GDMT in HFrEF.

→ [[cardio:heart_failure:start|Heart Failure Module]]

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==== Chronic Kidney Disease ★ ====

• Slows decline in GFR
• Reduces albuminuria
• Reduces risk of kidney failure

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===== Major Trials =====

EMPA-REG OUTCOME:

• Reduced cardiovascular death
• Reduced HF hospitalization

EMPEROR-Reduced:

• Benefit in HFrEF

EMPEROR-Preserved:

• Benefit in HFpEF

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===== Adverse Effects =====

Common:

• Genital mycotic infections
• Polyuria
• Volume depletion
• Hypotension

Serious (rare):

• Euglycemic DKA
• Fournier gangrene

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===== Contraindications / Cautions =====

• Type 1 diabetes
• Severe dehydration
• Advanced renal failure (indication-dependent)

Hold during:

• Acute illness
• Major surgery
• Prolonged fasting

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===== Empagliflozin vs Dapagliflozin =====

[[endocrine:sglt2:dapagliflozin|Dapagliflozin]]:

  * • Strong HF data (DAPA-HF)
  * • Strong CKD data (DAPA-CKD)

Empagliflozin:

  * • First to show CV mortality reduction
  * • Similar HF and renal benefit

Clinically interchangeable in most HF patients.

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===== Clinical Pearls =====

✔ First SGLT2 inhibitor to reduce CV mortality  
✔ Effective in HFrEF and HFpEF  
✔ Slows CKD progression  
✔ Benefits independent of diabetes  
✔ Mild diuretic effect  
✔ Hold during acute illness  

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Related:

→ [[cardio:heart_failure:start|Heart Failure Module]]
→ [[endocrine:sglt2:start|SGLT2 Inhibitors Overview]]
→ [[cardio:intro:start|Cardiovascular Modules]]