Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that holds an important position in the treatment of type 2 diabetes mellitus, heart failure, and chronic kidney disease.
Precautions for Empagliflozin Administration
Screening of Renal Function and Volume Status
Before initiating empagliflozin treatment, renal function testing and volume status assessment must be conducted.
For patients with renal impairment, elderly patients, or those using loop diuretics, special attention should be paid to screening for the risk of dehydration.
If there is significant hypovolemia, this condition should be fully corrected before medication administration to avoid inducing symptomatic hypotension or acute kidney injury.
Screening of Contraindications
Confirm whether the patient has a history of hypersensitivity to empagliflozin or its excipients; such patients are contraindicated from using this product.
Patients who have experienced severe allergic reactions (such as angioedema) during previous use of SGLT2 inhibitors must discontinue the medication permanently.
Prevention and Management of Ketoacidosis
Empagliflozin may increase the risk of ketoacidosis in patients with type 1 diabetes mellitus and some patients with type 2 diabetes mellitus.
Special attention should be paid to atypical manifestations—namely, ketoacidosis occurring when blood glucose levels are < 250 mg/dL. This may be triggered by factors such as insulin dose reduction, infection, surgery, alcohol consumption, or an extremely low-carbohydrate diet.
If a patient experiences symptoms such as nausea, vomiting, abdominal pain, fatigue, or difficulty breathing, they should discontinue the medication immediately and seek emergency medical attention.
Monitoring of Urinary Tract Infections
The risk of urinary tract infections may increase during medication use, and severe cases can progress to urosepsis or pyelonephritis.
Patients should be instructed to recognize the symptoms of urinary tract infections (e.g., painful urination, frequent urination, hematuria, fever, low back pain). Once such symptoms are detected, anti-infective treatment should be initiated immediately.
Monitoring During Empagliflozin Administration
Dynamic Monitoring of Metabolic Indicators
Regular testing of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and changes in body weight is required.
For patients with heart failure, special attention should be paid to cardiovascular mortality and heart failure hospitalization rates.
Specialist Monitoring Items
Foot examination: Evaluate quarterly for the presence of ulcers, infections, or signs of insufficient blood supply, and establish a preventive foot care plan.
Precautions for Special Tests
Due to the increased urinary glucose excretion caused by the medication, urine glucose tests or 1,5-anhydroglucitol (1,5-AG) tests should be avoided for assessing blood glucose control. It is recommended to use plasma glucose or glycated hemoglobin (HbA1c) for monitoring.
