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Empagliflozin, known to many under the trade name Jardiance, is one of the most discussed medicines of recent years. Originally developed as an agent against type 2 diabetes, it has surprisingly also proven to be a protection for the heart and kidneys. This triple benefit makes it an important building block of modern treatment. But where advertising likes to emphasise the benefit, two risks clearly belong to the picture: genital and urinary tract infections as well as a rare but dangerous metabolic derailment called ketoacidosis, which can occur even with normal blood sugar. This guide explains both openly and factually. It does not replace medical advice but helps you ask informed questions.
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One of the most common side effects of empagliflozin is gladly kept quiet in advertising but belongs to honest information: genital and urinary tract infections. The reason lies directly in the principle of action. Because the agent excretes sugar through the urine, a sugar-rich, moist environment arises in the genital and urinary tract area in which fungi and bacteria feel especially comfortable. In women this often shows as vaginal thrush with itching and discharge, in men as an inflammation of the glans. Urinary tract infections also occur more frequently. This side effect is no sign of a lack of hygiene but a direct consequence of the sugar-excreting effect of the agent and therefore in principle affects everyone who takes it. People who in the past have already tended towards such infections are somewhat more at risk and should pay particular attention to first signs.
The good news: these infections are as a rule well treatable and leave no lasting damage. Careful intimate hygiene and sufficient drinking can prevent them. If infections occur repeatedly, this should be discussed medically; sometimes a different agent is then sensible. Important is not to keep quiet about such complaints out of shame but to address them openly, because they belong to the treatment and can be well brought under control.
Rare emergency: Fournier's gangrene
In very rare cases a severe, rapidly progressing inflammation in the perineal area can develop from a genital infection, a so-called Fournier's gangrene. Warning signs are strong pain, swelling, redness and tenderness in the area of the genitals and anus, often accompanied by fever and a severe feeling of illness. This is a life-threatening emergency. If such complaints occur, call the emergency number 112 immediately or seek an emergency department without delay.
The second important warning concerns the diabetic ketoacidosis, a dangerous over-acidification of the blood. Normally it occurs with strongly raised blood sugar. The tricky thing with SGLT2 inhibitors such as empagliflozin is that it can also arise with normal or only slightly raised blood sugar. Experts then speak of a euglycaemic ketoacidosis. Because the blood sugar value seems unremarkable, the danger is easily overlooked, by those affected as well as by those treating. Exactly for this reason it is so important to know the warning signs.
Among the warning signs of a ketoacidosis are nausea, vomiting, abdominal pain, a fast and deep breathing, excessive thirst, confusion and unusual exhaustion. Sometimes the breath smells fruity of acetone. Triggers are often stress situations such as severe infections, longer fasting, a very low-carbohydrate diet, strong fluid losses, alcohol or operations. If such symptoms occur, this is an emergency that must be clarified medically immediately. The agent should then not be taken further until the situation is clarified. It is helpful to keep in mind that a normal blood sugar value in this situation is no reason for an all-clear, because the over-acidification can exist precisely under SGLT2 inhibitors even without high sugar. Anyone who knows about this peculiarity can make the right decision faster in an emergency and should expressly point out to the treatment team that an SGLT2 inhibitor is being taken.
Sick-day rules: when to pause?
With severe acute illness with fever, vomiting or diarrhoea, with longer fasting, with strong fluid losses and before planned operations, empagliflozin should be paused after medical consultation because the risk of a ketoacidosis then rises. Before plannable procedures it is often stopped a few days beforehand. Discuss these so-called sick-day rules with your medical practice before such a case arises. But do not stop the agent permanently without consultation, because otherwise the protection for the heart and kidneys falls away.
| Topic | The most important in brief |
|---|---|
| Substance group | SGLT2 inhibitor, excretes sugar through the urine |
| Use | Type 2 diabetes, heart failure, kidney disease |
| Common side effect | Genital and urinary tract infections, such as thrush |
| Rare danger | Ketoacidosis, possible even with normal blood sugar |
| Pausing | With severe illness, fasting, before operations |
Besides the infections and the rare ketoacidosis there are further points one should know. Because empagliflozin drains the body slightly, a fluid deficiency can occur that makes itself noticeable through dizziness, low blood pressure and increased thirst. Especially older people and persons who additionally take draining agents are at risk here. Therefore it is important to drink enough, above all on hot days or with gastrointestinal infections. A hypoglycaemia is rare with sole use but can occur in combination with insulin or certain other diabetes agents. In such cases the dose of these additional agents is sometimes adjusted to lower the risk. It is worthwhile to know the signs of a hypoglycaemia such as trembling, sweating, ravenous hunger and difficulty concentrating, so that one can counteract in time.
A frequent pleasant side effect is a slight weight loss of usually one to two kilograms, because calories are excreted along with the sugar. This is, however, no reason to use the agent as a slimming aid; it is not intended and not approved for this. Also important: empagliflozin should not be stopped permanently on your own, because then the protective effect is lost and the underlying disease can worsen. A classic withdrawal syndrome does not exist, but the underlying disease needs a continuous treatment. Anyone who has concerns or side effects should therefore not simply leave the agent out but seek the conversation with the medical practice, which decides together with you about the further approach.
Make sure to drink enough
Because empagliflozin drains, it is important to drink enough, especially on hot days, with physical exertion or with gastrointestinal infections with vomiting or diarrhoea. Signs of a fluid deficiency are dizziness when standing up, tiredness and a dry mouth. If you additionally take draining agents or are older, special caution is advised. Talk with your medical practice about how much fluid is sensible in your situation.
Empagliflozin is often part of a long-term treatment with several medicines. brite helps you manage your agents, be reminded of intake and get notes on possible interactions. This way you keep the overview over diabetes, heart and kidney therapy in one place.
In sum, empagliflozin is a remarkable medicine that can benefit threefold with type 2 diabetes, heart weakness and kidney disease and means a real advance for many chronically ill people. Honest information belongs to the picture, though: the common genital and urinary tract infections and the rare but dangerous ketoacidosis should be known so that warning signs are recognised early and one reacts correctly. Advertising and product information understandably put the benefit in the foreground, but a complete picture only arises when the downsides are clearly named too. Exactly this complete picture is the basis for being able to trust the agent and at the same time accompany it attentively. With type 2 diabetes, a heart failure or a chronic kidney disease, empagliflozin is often an important building block that unfolds its strength in interplay with the rest of the treatment. Anyone who knows the benefits and risks can use the agent informed and safely.
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This guide serves general information and does not replace medical advice, diagnosis or treatment. It contains no dosage recommendation. Take empagliflozin only on medical prescription, do not pause or end it on your own and discuss warning signs and sick-day rules with your medical practice or pharmacy.
