Empagliflozin Dosing for Type 2 Diabetes Mellitus

Dosing Recommendations

The American College of Cardiology recommends initiating empagliflozin at 10 mg orally once daily as the standard starting dose for patients with type 2 diabetes mellitus, providing optimal cardiovascular and glycemic benefits with a favorable safety profile 1, 2, 3
The 10 mg daily dose of empagliflozin has demonstrated significant cardiovascular risk reduction in patients with established cardiovascular disease, according to the American College of Cardiology 1, 2
No dose titration is needed for cardiovascular or renal risk reduction benefits with empagliflozin, as there is no evidence of a graded dose response for these outcomes, as stated by the American College of Cardiology 3
Dose increases to 25 mg daily may provide additional glucose-lowering benefits with empagliflozin if glycemic targets are not met with the 10 mg dose, but do not offer additional cardiovascular protection, as recommended by the American College of Cardiology 3

For patients with renal impairment, the American College of Cardiology and Kidney International recommend that empagliflozin is not recommended for glycemic control if eGFR <45 mL/min/1.73 m² 4, 5
Empagliflozin is contraindicated in patients with severe renal impairment or those on dialysis, according to the American College of Cardiology 1, 2

When initiating empagliflozin, the American College of Cardiology recommends considering reducing or stopping sulfonylureas/glinides or reducing total daily insulin dose by approximately 20% to prevent hypoglycemia 1, 2
The American College of Cardiology advises discontinuing empagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis 1, 2
Empagliflozin may be used in children with type 2 diabetes aged 10-17 years, with the same starting dose of 10 mg daily, as recommended by Diabetes Care 6

For most patients with type 2 diabetes mellitus, the American College of Cardiology recommends starting with 10 mg daily of empagliflozin 1, 2
For patients with established cardiovascular disease, 10 mg daily of empagliflozin is sufficient for cardiovascular risk reduction, according to the American College of Cardiology 1, 2, 3

Initiating empagliflozin in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²) is not recommended by the American College of Cardiology and Kidney International 1, 2, 4
Failing to reduce concomitant insulin or sulfonylurea doses when starting empagliflozin may increase hypoglycemia risk, as warned by the American College of Cardiology 1, 2
Not discontinuing empagliflozin before surgical procedures increases ketoacidosis risk, according to the American College of Cardiology 1, 2