Figure. Physiological effects of empagliflozin and related adverse reactions.

Empagliflozin promotes glucosuria, diuresis, and natriuresis at the level of the proximal tubule in the kidney. Increased levels of urinary glucose may predispose patients to urinary tract or genital infection and may increase the risk for hypoglycemia, especially when used in combination with insulin or sulfonylureas. The diuretic and natriuretic effects may exacerbate volume depletion and increase the risk for hypotension especially among those with renal impairment, the elderly, in patients with low baseline systolic blood pressure, and in patients taking diuretics. Effects with an unknown physiologic mechanism include a small increase in LDL cholesterol levels and increases in hemoglobin and hematocrit, the clinical relevance which is not known.