2. Introduction
History
Chemical structure
Pharmacodynamics
Pharmacokinetics
Indications
Limitation of use
Adverse reactions
Drug interaction
Cardiovascular outcome
3. Empagliflozin belongs to sodium glucose co-
transporter 2 inhibitor group.
Other drugs belonging to this group are
dapagliflozin , sergliflozin , remogliflozin ,
canagliflozin
4.
5. It was developed by Boehringer Ingelheim
& Eli Lilly and company
It was approved by FDA in august 2014
It was approved for medical use in the US
in 2014
6. A month supply in the UK costs the NHS
about 36.59 £ as of 2019.
In the US the wholesale cost of this
amount is about US $ 442 .
In the 2016 it was the 289th most
prescribed medication in the US with more
than a million prescription.
8. Empagliflozin
Inhibits SGLT2 at PCT
in kidney
Prevention of
reabsorption of glucose
Excretion of glucose in
urine
Reduction of blood
glucose
9.
10.
11. Tablets available as :
Starting dose 10mg ,
Maximum dose 25mg ,
Once daily in the morning .
12. May be taken with or without food.
Route by oral.
13. Absorption :
no clinically relevant effects of food.
Distribution : Vd 73.8L
Steady state 5-6 days
37% in RBC and
63% in plasma protein bound
14. Metabolism :
primary route of metabolism is hepatic
glucuronidation by uridine 5’
diphosphoglucuronosyltransferase.
15. Excretion :
half life is 12.4 hr.
Clearance 10.6l/hr.
41% eliminated in feces.
54%eliminated in urine.
16. As an adjunct to diet & exercise to improve
glycemic control in adults with type 2 DM.
To reduce the risk of cardiovascular death
in adult patients with type 2DM &
established cardiovascular disease.
17. Good second line option in obese patients
with type 2 DM.
Patients with renal impairment (GFR
greater than or equal to 45ml/min/1.73m².
18. Type 2 DM with hepatic impairment.
Second line medications after Metformin
for type 2 DM in people with heart failure or
CKD.
19. Type 1 DM
GFR <45ml/min/1.73m2
History of hypersensitivity reaction to
Empagliflozin
Diabetic ketoacidosis
Severe renal impairment , ESRD or
dialysis
27. Reduction in intravascular volume ( preload)
Improvement in arterial pressure & aortic
stiffness (after load)
Improve ventricular function & myocardial
oxygen demand , this could be an especially
attractive option for patients with reduced EF
& heart failure
28. The effect of empagliflozin on
cardiovascular risk in adult patients with
type 2 DM & established, stable,
atherosclerotic cardiovascular disease was
evaluated in the EMPA-REG OUTCOME
study.
29. The EMPA-REG Outcomes trial has the
potential to change dramatically the way
these drugs are now used.
30. The empagliflozin cardiovascular outcome
event trial in type 2 DM patients-Removing
Excess Glucose(EMPA-REG) Outcomes
trial evaluated 7028 patients with T2DM
and high risk of cardiovascular events to
empagliflozin standards of care versus
placebo standard of care..
31. Over a median follow up of 3.1 years,
treatment with empagliflozin reduced the
primary composite outcome (death from
cardiovascular causes ,non fatal MI , or
nonfatal stroke) from 12.1% to 10.5%.
32. A decrease in cardiovascular mortality from
5.9% to 3.7% was noted in the treatment
group along with a remarkable 35%
relative risk reduction in hospitalization for
heart failure.
33. Empagliflozin also causes small reduction
in weight, waist circumference , uric acid
level, blood pressure and reduction in
cardiovascular events.
34.
35. ADA & EASD guideline 2019.
Davidson's Principles and Practice of
Medicine( 23rd edition).
Drugs for the heart.
Manual of Cardiovascular Medicine( 5th
Edition).
