Short summary with quick facts

Empagliflozin is an oral glucose lowering medication used primarily in type 2 diabetes. It is available in the UK in common tablet strengths of 10 mg and 25 mg and has additional benefits for certain people with heart failure or established cardiovascular disease.

• Primary active ingredient: empagliflozin
• Main roles: improve blood sugar control; reduce cardiovascular death in selected patients; lower heart failure admissions in appropriate cases
• Typical UK tablet sizes: 10 mg and 25 mg

For a brief explanation of its action see The operation and portents.

How the the internal mechanism works and why it is prescribed

Empagliflozin belongs to the sodium glucose cotransporter 2 (SGLT2) inhibitor class. It reduces the amount of glucose reabsorbed by the kidneys so more sugar is passed in the urine, which helps to lower blood glucose concentrations.

Primary signs in clinical practice in the UK include:

• Sustaining better glycaemic control in adults and in children aged 10 years and older with type 2 diabetes when combined with diet and exercise
• Reducing the risk of death from cardiovascular causes in people with type 2 diabetes who have established heart disease
• Lowering risk of death and hospitalisation for symptomatic heart failure in selected patients

This medicine is not suitable for type 1 diabetes management. Look up dosing details in the patient leaflet. Taking empagliflozin - dosing.

Administering empagliflozin: how to swallow it and baseline dosing

Follow the directions on your prescription label in conjunction with the patient information leaflet. Clinicians commonly start with a standard dose and may change it depending on blood glucose control and kidney function.

• Frequency: once daily is usual, often taken in the morning; tablets can be taken with or without food
• Automated monitoring: regular checks of blood glucose and renal function are usually recommended; ketone testing may be advised in some situations
• Hydration: maintain good fluid intake, especially during illness, hot weather, or after intense exercise

If you are unsure about dose changes or keeping track of metrics requirements speak to your GP or pharmacist. For safety guidelines to follow refer to Guidelines for protecting people with safety and mitigating steps.

Safety verification procedures and mitigating steps before starting empagliflozin

Prior to starting treatment begins, tell your prescriber about any of the following factors so they can assess suitability and ongoing monitoring needs:

• Recurrent urinary tract infections or recent urinary problems
• Past genital fungal infections such as thrush or balanitis
• History of severe pancreatic disease or pancreatic surgery
• Significant alcohol intake or a history of alcohol misuse
• Periods of poor oral intake, very low salt diets, or anything that raises dehydration risk
• Age 65 or older, as older patients may require closer performance monitoring
• Known liver disease or impaired kidney function

If you are pregnant or trying to conceive, or breastfeeding, discuss this with your clinician because empagliflozin is not recommended in pregnancy and should be avoided during breastfeeding. See Reasons to avoid use and pregnancy to learn more details.

Who ought not to use empagliflozin?

Empagliflozin should be avoided in some situations. Tell your prescriber if any of the following apply to you:

• Allergy to empagliflozin or any ingredient in the product
• Severe renal impairment, end stage renal disease, or if you are on dialysis
• Pregnancy in the second and third trimesters
• Breastfeeding mothers

Be cautious with alcohol because it can worsen dehydration and increase the risk of diabetic ketoacidosis. Also take care standing up quickly if you feel light headed or dizzy.

Secondary reactions and when to get medical help

Urgent emergency signs

• Severe allergic reaction: widespread rash, difficulty breathing, or swelling of face, lips, tongue or throat
• Rapidly worsening genital infection with severe pain, marked swelling or an offensive discharge, fever, or feeling very unwell

Serious problems needing prompt attention

• Very low blood pressure or fainting
• Hypoglycaemia symptoms when used with insulin or sulfonylureas: sweating, trembling, chronic head pain, confusion
• Dehydration signs: extreme thirst, low urine output, dizziness, confusion
• Possible ketoacidosis: persistent nausea or vomiting, severe abdominal pain, extreme fatigue, breathing difficulties
• Urinary infection with fever, pelvic or back pain, or blood in the urine

More frequently reported reactions

• Urinary tract infection episodes
• Genital fungal infections such as yeast infections

If you experience a suspected adverse effect report it via the MHRA Yellow Card scheme and seek advice as needed. For the interaction between participants advice see Interactions with others and lifestyle tips.

Adverse clinically relevant drug interpersonal engagement possibilities and lifestyle considerations

List all medicines, herbal products and supplements to your prescriber or pharmacist so the back and forth of communications among teammates fuel progress. can be reviewed.

• Insulin and sulfonylureas: combined use increases the risk of hypoglycaemia; dose reductions may be required
• Diuretics: concurrent use can heighten the chance of low blood pressure and dehydration
• Other antihypertensive medications: additive blood pressure lowering may cause symptoms
• Very low carbohydrate or ketogenic diets and heavy alcohol use can increase the risk of ketoacidosis and should be discussed with your clinician

Practical day to day guidance including i failed to take a dose rules is available at Missed structured dosing guidance.

Missed dosing protocol guidance

As soon as you forget a dose take it as soon as you remember unless the next dose is due shortly. If the next scheduled dose is near, skip the the dose was missed. Do not take two doses together to make up for a missed tablet.

Handling a drug overdose case with emergency actions

If you suspect an overdose incident seek immediate medical help, call your local emergency services or NHS 111 for advice. Take the medicine packaging with you to the healthcare facility if possible.

Global optimized storage layouts improve overall efficiency., handling and safe disposal

• Keep at normal room temperature, protected from excessive heat and damp
• Store out of sight and reach of children and pets
• Return unused or out of date medicines to a pharmacy for safe disposal where the service is available; do not dispose of them in household waste if an a different option to consider is provided

Other avenues and medicines with similar effects

Several other SGLT2 inhibitors and combination preparations may be considered depending on clinical goals, side effect profile and cost. Talk through the available options in partnership with your prescriber.

• Dapagliflozin (Forxiga) - common dose 10 mg once daily
• Ertugliflozin (Steglatro) - available in once daily doses
• Canagliflozin (Invokana) - effective but has been linked in some reports to rare bone density and lower limb events

Fixed dose combinations that can reduce pill burden include:

• Empagliflozin plus metformin (for example Synjardy)
• Empagliflozin plus a DPP-4 inhibitor such as linagliptin (Glyxambi)

Other diabetes treatment classes to consider:

• Metformin - first line therapy for many people and generally low cost
• GLP-1 receptor agonists (for example semaglutide, dulaglutide) - often help weight loss and have cardiovascular benefits but are usually more expensive
• DPP-4 inhibitors - generally weight neutral with low hypoglycaemia risk
• Sulfonylureas - effective for glucose lowering but higher hypoglycaemia risk
• Insulin - required for some patients or when oral agents are inadequate

To get a quick cost comparison, see Indicative UK price information guide for shoppers.

Indicative UK charging rates guide for private purchase

The following approximate private prices are for a pack of about 28 to 30 tablets. Prices change over time and vary by supplier.

• Empagliflozin 10 mg: around 30 to 50 GBP per pack
• Empagliflozin 25 mg: around 35 to 55 GBP per pack
• Dapagliflozin 10 mg: around 30 to 50 GBP per pack
• Ertugliflozin (5-15 mg): around 35 to 55 GBP per pack
• Canagliflozin (100-300 mg): around 35 to 55 GBP per pack
• Joint products (eg empagliflozin plus metformin): commonly 45 to 80 GBP per pack

Generic metformin is substantially cheaper monthly, while GLP-1 receptor agonists usually have higher costs than SGLT2 inhibitors. On the NHS prescription charges in England apply per item; prescriptions are free to most patients in Scotland, Wales and Northern Ireland. For current prices and NHS charging rules check official sources or your local pharmacy.

For regulatory and supply information see UK advice on regulatory and legal matters materials.

Guidance on UK law and regulation

Core takeaways about supply, safety reporting and remote services in the UK:

• Classification: empagliflozin is a Prescription Only Medicine (POM) in the UK
• Regulation: the MHRA licences the product and oversees safety; report suspected reactions through the Yellow Card scheme
• Dispensing: must be dispensed by a UK-registered pharmacist against a valid prescription from a UK prescriber such as a GP or independent prescriber
• Online pharmacies: use only services registered with the General Pharmaceutical Council (GPhC) that follow safe remote consultation procedures
• Remote prescribing: permitted when a proper clinical assessment has been completed and documented; reputable providers will request medical history and may contact your GP
• Importation: do not import prescription medicines without complying with UK rules and holding a valid prescription; unauthorised imports carry customs and regulatory risk
• Driving: main concern is hypoglycaemia when empagliflozin is used with insulin or sulfonylureas; follow DVLA guidance for recurrent hypoglycaemia
• Prenatal and postnatal breastfeeding: empagliflozin is contraindicated in the second and third trimesters and not recommended during breastfeeding; seek specialist advice if pregnancy is planned or suspected
• Paediatric use: licensed for type 2 diabetes from age 10 in selected situations; specialist dosing and watchful oversight guidance should be followed

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