In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.
The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.
What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?