2 The technology
2.1 Empagliflozin (Jardiance, Boehringer Ingelheim) is an orally administered selective sodium‑glucose cotransporter‑2 (SGLT‑2) inhibitor, which lowers blood glucose in people with type 2 diabetes by blocking the reabsorption of glucose in the kidneys and promoting excretion of excess glucose in the urine.
2.2 Empagliflozin has a European marketing authorisation for the treatment of type 2 diabetes to improve glycaemic control in adults as:
'Monotherapy when diet and exercise alone do not provide adequate glycaemic control in patients for whom use of metformin is considered inappropriate due to intolerance.
Add‑on combination therapy with other glucose‑lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control'.
2.3 The recommended starting dosage is 10 mg once daily for both monotherapy and as an add‑on combination therapy with other glucose‑lowering medicinal products including insulin. According to the summary of product characteristics, the dosage can be increased to a maximum of 25 mg daily for people who tolerate empagliflozin well and need tighter glycaemic control, if they have an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2 or more.
2.4 The summary of product characteristics states the following adverse reactions for empagliflozin as the most commonly reported: hypoglycaemia in combination with insulin or a sulfonylurea, vulvovaginal candidiasis, urinary tract infection, and polyuria or pollakiuria (that is, urinary frequency). For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.5 The cost of empagliflozin is £36.59 (excluding VAT) per pack of 28 tablets for both 10 mg and 25 mg doses (MIMS December 2014). The annual cost of empagliflozin is estimated to be £477.30. Costs may vary in different settings because of negotiated procurement discounts.