Empagliflozin

Empagliflozin is a sodium-glucose co-transporter-2 (sglt2) inhibitor — oral antidiabetic with heart and kidney benefits medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Your doctor may prescribe Empagliflozin for:

• Type 2 diabetes in adults, with diet and exercise — alone or combined with metformin, other diabetes tablets or insulin
• Heart failure — to reduce the risk of worsening heart failure and hospital admission, in some patients even without diabetes
• Chronic kidney disease — to slow further loss of kidney function in selected patients

It is not used for type 1 diabetes or to treat diabetic ketoacidosis. Whether Empagliflozin is suitable, and for which purpose, depends on your kidney function and overall condition — your doctor will decide.

Because Empagliflozin removes sugar through the urine, the most common side effects are:

• Genital yeast infections — itching, redness or discharge, more common in women
• Urinary tract infections — burning or pain when passing urine
• Passing urine more often, thirst, and occasionally dizziness or low blood pressure from fluid loss

Rare but serious: diabetic ketoacidosis (DKA), which can occur even with near-normal blood sugar — nausea, vomiting, stomach pain, rapid breathing, unusual tiredness or fruity-smelling breath need urgent hospital care. Very rarely, a severe infection of the tissue around the genitals (Fournier's gangrene) — severe pain, swelling and fever in that area — is an emergency. Low blood sugar can occur when combined with insulin or a sulfonylurea.

To use Empagliflozin safely:

• Maintain genital hygiene — wash gently and keep the area dry every day; this greatly reduces yeast infections. See a doctor early if itching or discharge appears.
• Avoid dehydration — drink enough water, especially in hot weather, during fever or diarrhoea, or if you take diuretics; elderly people are more vulnerable.
• Tell your doctor before planned surgery, during any serious illness, or before prolonged fasting such as Ramadan — the medicine is often held temporarily to avoid DKA.
• A routine urine test will show sugar while you take this medicine — this is expected, not a sign of worsening diabetes.

Do not stop Empagliflozin on your own; its heart and kidney protection works only with regular use.

Tell your doctor and pharmacist about every medicine you take. Important interactions with Empagliflozin:

• Diuretics (water tablets) — combined fluid loss can cause dehydration, dizziness and low blood pressure; doses may need adjusting.
• Insulin and sulfonylureas (e.g. glimepiride, gliclazide) — higher risk of low blood sugar; your doctor may reduce their dose when starting Empagliflozin.
• Blood pressure medicines — the added blood-pressure-lowering effect may cause light-headedness, especially on standing.
• Lithium — empagliflozin may lower lithium levels; extra monitoring is advised.

Also mention NSAID painkillers and any herbal or over-the-counter products, since they can affect kidney function and hydration.

Do not take Empagliflozin if:

• You are allergic to Empagliflozin or any other ingredient of the product
• You have type 1 diabetes — the risk of ketoacidosis is high
• You currently have diabetic ketoacidosis — this medicine does not treat it

It is generally avoided in people with severely reduced kidney function or on dialysis (the doctor decides based on the purpose of treatment), in severe dehydration, and during pregnancy or breastfeeding. If you have repeated genital infections, very low blood pressure or a history of DKA, discuss carefully with your doctor before using Empagliflozin.

Empagliflozin is not recommended during pregnancy, particularly from the fourth month onwards, because animal studies suggest possible effects on the developing kidneys of the baby. Pregnant women with diabetes are usually managed with insulin instead. If you become pregnant or plan a pregnancy, inform your doctor promptly so treatment can be switched safely — do not just stop your diabetes care.

It is not known whether empagliflozin passes into human breast milk, and it is not recommended while breastfeeding. Your doctor will suggest a suitable alternative for this period.

Store Empagliflozin below 30°C in a cool, dry place, away from direct sunlight and moisture. Keep the in its original blister or container until you take it, and avoid storing medicine in the bathroom or kitchen where humidity is high.

• Keep all medicines out of the reach and sight of children.
• Do not use the medicine after the expiry date printed on the pack.
• Do not dispose of unused medicine in household waste or drains; ask your pharmacist about safe disposal.