Empagliflozin — NZ Medication Guide
📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.
What is Empagliflozin?
Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used for type 2 diabetes and heart failure. This medication is funded by Pharmac under Special Authority for type 2 diabetes with CVD and heart failure (HFrEF).
What is Empagliflozin Used For?
Empagliflozin is used for type 2 diabetes to improve blood glucose control and reduce cardiovascular death in patients with established cardiovascular disease. It is also approved for heart failure with reduced ejection fraction (HFrEF) regardless of diabetes status.
How Does Empagliflozin Work?
Empagliflozin blocks SGLT2 transporters in the kidney, which are responsible for ~90% of glucose reabsorption from the renal tubule. By inhibiting these transporters, excess glucose is excreted in the urine, lowering blood glucose. It also reduces blood pressure, body weight, and cardiac preload/afterload — contributing to cardiovascular and renal protection.
How to Take Empagliflozin
Taken once daily in the morning, with or without food. Standard dose: 10 mg/day. Can be increased to 25 mg/day for additional glucose lowering. Dose adjustment not required for hepatic impairment, but not recommended if eGFR <45 mL/min/1.73m² for glucose-lowering indication (can be continued down to eGFR 20 for heart failure).
Common Side Effects of Empagliflozin
- Genital mycotic (fungal) infections (thrush) — very common; maintain good hygiene
- Urinary tract infections
- Increased urinary frequency
- Thirst and dehydration
Serious Side Effects — Seek Medical Attention
Contact your doctor or call 111 immediately if you experience any of the following:
- Diabetic ketoacidosis (DKA) — can occur even with near-normal blood glucose (euglycaemic DKA); hold dose 3 days before major surgery or prolonged fasting
- Fournier’s gangrene (rare — necrotising fasciitis of the perineum — seek emergency care for fever and genital/perineal pain)
- Urosepsis
- Lower limb amputations (possible small risk — maintain good foot care)
- Volume depletion (particularly in elderly patients or those on diuretics)
Drug Interactions
Empagliflozin may interact with other medicines. Always inform your doctor and pharmacist of all medications you are taking. Key interactions include:
- Diuretics (enhanced diuretic effect — risk of volume depletion and hypotension)
- Insulin and sulfonylureas (empagliflozin can mask DKA features — increased monitoring needed)
New Zealand Prescribing Information
Empagliflozin (Jardiance® 10 mg, 25 mg tablets) is funded by Pharmac under Special Authority for patients with type 2 diabetes and established cardiovascular disease, and for heart failure with reduced ejection fraction. Its cardiovascular and renal protective effects (demonstrated in the EMPA-REG OUTCOME and EMPEROR-Reduced trials) are now the primary reason for its use in many high-risk patients.
Frequently Asked Questions
How does empagliflozin protect the heart?
Beyond blood glucose lowering, empagliflozin reduces cardiac preload and afterload by promoting mild diuresis, lowers blood pressure, reduces inflammation and fibrosis, and improves cardiac energy metabolism. These effects reduce hospitalisation for heart failure and cardiovascular death independent of glucose-lowering.
Should I stop empagliflozin before surgery?
Yes — empagliflozin should be withheld for at least 3 days before any major surgery, general anaesthesia, or prolonged fasting. This reduces the risk of euglycaemic DKA (ketoacidosis with normal blood sugar), which can develop during periods of reduced carbohydrate intake.
⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for current information.
Reviewed by a Registered Pharmacist NZ
References & Further Information
The following New Zealand and international resources were used to inform this page: