Diuretics
Coadministration of Empaglibet® with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion. Before initiating Empaglibet®, assess volume status and renal function. In patients with volume depletion, correct this condition before initiating Empaglibet®. Monitor for signs and symptoms of volume depletion, and renal function after initiating therapy.
Insulin or Insulin Secretagogues
The risk of hypoglycemia is increased when Empaglibet® is used in combination with insulin secretagogues (e.g., sulfonylurea) or insulin. Coadministration of Empaglibet® with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.
Lithium
Concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations. Monitor serum lithium concentration more frequently during Empaglibet® initiation and dosage changes.
Positive Urine Glucose Test
SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests. Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.
Interference with 1,5-anhydroglucitol (1,5-AG) Assay
Measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors. Monitoring glycemic control with 1,5-AG assay is not recommended. Use alternative methods to monitor glycemic control.
Inducers of UGT enzymes
Co-treatment with known inducers of UGT enzymes is not recommended due to a potential risk of decreased efficacy. If an inducer of these UGT enzymes (e.g. Rifampicin, phenobarbital, phenytoin, and carbamazepine, …) must be co-administered, monitoring of glycemic control to assess response to Empaglibet® is appropriate.