A patient taking EMPAGLIFLOZIN should be counselled about which characteristic adverse effect?

Correct answer: B. Urinary tract and genital fungal infections

• A. They act as osmotic diuretics and tend to REDUCE fluid volume and blood pressure. Peripheral oedema is characteristic of the thiazolidinediones (pioglitazone) instead.
• B. CORRECT. EMPAGLIFLOZIN is an SGLT2 INHIBITOR. It blocks glucose reabsorption in the proximal tubule, so glucose is deliberately excreted in the urine. That glucose-rich urine is an excellent culture medium, making URINARY TRACT INFECTIONS and GENITAL MYCOTIC INFECTIONS (candidal vulvovaginitis and balanitis) the signature adverse effects. Rare but serious risks are euglycaemic diabetic ketoacidosis and necrotising fasciitis of the perineum (Fournier gangrene).
• C. They cause modest WEIGHT LOSS, since a substantial number of calories are lost daily as urinary glucose — one of their attractions.
• D. SGLT2 inhibitors carry a LOW intrinsic hypoglycaemia risk because their action is insulin-independent. Hypoglycaemia occurs mainly when combined with insulin or a sulfonylurea.

Note: Dental relevance: the glucosuria and mild volume depletion predispose to ORAL CANDIDIASIS as well as genital candidiasis, and patients may report xerostomia. Ask about recurrent thrush and reinforce denture hygiene. SGLT2 inhibitors also have proven cardiovascular and renal protective benefits, which is why their use is expanding well beyond diabetes.