Sodium-glucose co-transporter 2 inhibitors (SGLT2i)
ATC code: A10BK03 (Empagliflozin)
Brand names
Jardiance
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.
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.
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.
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.
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.
FDA categories were retired in 2015. Manufacturer label contraindicates use in pregnancy — animal studies in the second and third trimesters showed adverse effects on fetal kidneys. In T2D patients planning pregnancy, transition to insulin or metformin together with the endocrinologist.
Breast milk transfer data are limited. The manufacturer label states a contraindication. Choose an alternative in breastfeeding patients.
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.
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.
FDA categories were retired in 2015. Manufacturer label contraindicates use in pregnancy — animal studies in the second and third trimesters showed adverse effects on fetal kidneys. In T2D patients planning pregnancy, transition to insulin or metformin together with the endocrinologist.
Breast milk transfer data are limited. The manufacturer label states a contraindication. Choose an alternative in breastfeeding patients.
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.