Not to be used in patients w/ type 1 diabetes. Discontinue use if diabetic ketoacidosis, pancreatitis, necrotizing fasciitis & bullous pemphigoid is suspected. Immediately assess patients if symptoms of diabetic ketoacidosis occur regardless of blood glucose level. Patients w/ very low carbohydrate diet, acute illness, pancreatic disorders suggesting insulin deficiency (eg, type 1 diabetes, history of pancreatitis or pancreatic surgery), insulin dose reduction (including pump failure), alcohol abuse, severe dehydration, & history of ketoacidosis. Consider temporary discontinuation for at least 3 days prior to surgery in patients who undergo scheduled surgery. Consider monitoring for ketoacidosis & temporarily discontinue treatment in clinical situations known to predispose to ketoacidosis. Monitor ketones, even if treatment is interrupted. Ensure risk factors for ketoacidosis are resolved prior to restarting treatment. Evaluate patients who present w/ pain or tenderness, erythema, genital or perineal swelling, fever, malaise for necrotizing fasciitis. Concomitant use w/ sulphonylurea or insulin. Assess renal function prior to initiation of treatment & periodically during treatment, ie, at least yrly. Patients for whom an empagliflozin-induced decrease in BP could pose a risk eg, patients w/ known CV disease, on antihypertensive therapy w/ history of hypotension, or patients ≥75 yr. Carefully monitor vol status (eg, physical exam, BP measurements, lab tests including hematocrit) & electrolytes. Consider temporary interruption of therapy until fluid loss is corrected & in patients w/ complicated UTI. Not recommended in patients w/ persistent eGFR <45 mL/min/1.73 m
2. Pregnancy (avoid use) & lactation (discontinue during treatment). Childn <18 yr. Increased risk of vol depletion in elderly ≥75 yr. Not recommended in childn <18 yr & elderly ≥85 yr.
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