Can you take empagliflozin with other vasodilators or BP medicines like sartans? Or is that just too much vasodilation?
I’m taking jardiance 25, nebivolol 5mg and Telmisartan 80mg, no side effects. BP is in the perfect range.
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I take dapagliflozin and telmisartan. I didn’t see any counter indication. SGLT2i and sartans are super common drug classes so it would be known if there was a counter indication.
A few papers argue that SGLT2i + ARBs combined have synergistic effects. See for instance: Mechanisms underlying the blood pressure-lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial 2022
In people with T2D, SGLT2 inhibition in combination with an ARB had a larger blood pressure-lowering effect versus placebo than either of the drugs alone. Our data further suggest that the mechanisms underlying these blood pressure reductions at least partially differ between these agents.
This may indicate that combination therapy may induce synergistic effects on blood pressure lowering, which is in line with a recently published meta-analysis, although we were underpowered to formally test this.
The meta-analysis cited above:
Compared with ACEI/ARB alone, the combination therapy with SGLT2 inhibitors and ACEIs/ARBs in T2DM was effective and well-tolerated and could achieve additional effects including better control of blood pressure, improvement of renal outcomes, alleviation of long-term renal function and a decrease in blood glucose and body weight. The combination therapy showed an increased risk of hypoglycaemia.
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Another more recent paper: Renoprotective potential of concomittant medications with SGLT2 inhibitors and renin-angiotensin system inhibitors in diabetic nephropathy without albuminuria: a retrospective cohort study 2023
In conclusion, SGLT2 inhibitors also have safeguarding effects in the stage of diabetic nephropathy without albuminuria, and the combined use of a SGLT2 inhibitor and a RAS inhibitor appears to be more effective than the single use of each.
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Does it matter if -flozins are enterically or film coated? the abovementioned Invonka is film-coated…
also looking at Shreeji_impex now…
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Enterically or film coated: no idea…
A few good articles:
Systemic and organ-specific anti-inflammatory effects of sodium-glucose cotransporter-2 inhibitors 2024
Evidence from animal models and human studies clearly demonstrate that sodium-glucose cotransporter-2 (SGLT2) inhibitors have systemic and tissue-specific anti-inflammatory effects that may be independent of glycemic control and weight loss.
SGLT2 inhibitors may achieve their anti-inflammatory effects through various mechanisms, including reduction of reactive oxygen species, inflammasome activation, intracellular sodium and calcium levels, circulating uric acid, and mitochondrial dysfunction.
The direct and indirect mitigation of inflammatory pathways by SGLT2 inhibitors may partially explain their cardiac and renoprotective effects. However, this remains to be formally demonstrated in human studies.
After controlling for relevant variables, the SGLT-2i cohort (aHR = 0.90, 95% CI = 0.87–0.93) had a significantly lower risk of developing cancer than the DPP-4i cohort, particularly when the SGLT-2i was dapagliflozin (aHR = 0.91, 95% CI = 0.87–0.95) or empagliflozin (aHR = 0.90, 95% CI = 0.86–0.94). Regarding cancer type, the SGLT-2i cohort’s risk of cancer was significantly lower than that of the DPP-4i cohort for leukaemia, oesophageal, colorectal, liver, pancreatic, lung, skin and bladder cancer.
In high-risk, treatment-naïve diabetic patients, initiating SGLT2i therapy alone or in combination with metformin resulted in comparable cardiovascular and renal outcomes. These findings suggest that metformin might not be mandatory as a first-line treatment for achieving cardiovascular benefits in such patients.
Compared to the control group, patients treated with empagliflozin using repeated-measures ANOVA showed greater improvement in reducing the severity of depression symptoms over time (p value = 0.0001).
(I’ve been feeling way better in terms of mood since I started taking dapagliflozin, n=1 but the above findings confirm my intuition…)
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They are film-coated. I believe this is mostly to do in order to discourage half/quarter dosing by doctors.
They are film coated and it’s just to make it easier to swallow.
I don’t view this argument as the sole reason behind the instructions not to halve the medication. It seems there may be an ulterior motive at play. The leaflet’s statement about not halving the pills, along with the peculiar shapes of some flozin medications, could be intentional efforts to discourage halving and ensure full dosage consumption. Studies have indeed shown that flozins can be effective at half doses or even every other day, potentially leading to significant cost savings for national insurers. However, if manufacturers allowed pill halving, it could result in reduced profits, especially since both doses are priced the same. Additionally, the fact that empaglifozin’s lower dose isn’t exactly half of the larger dose further supports this notion.
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That is great, thx. Could you point to a key one or two.
@AlexKChen and others see the threads about the AgelessRx mini trial on halving Cana pills for longevity contexts
This is one example.
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Thanks
After the treatment for 24 weeks, the HbA1c level was decreased both in group A (from 7.5%±1.1% to 6.5%±0.8%) and in group B (from 7.6%±0.8% to 7.2%±0.5%). This pilot trial suggested the possibility of 10-mg every other day administration with empagliflozin for Japanese patients with type 2 diabetes mellitus.
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I’m not much of an expert but 3 grams of chromium sound like a lot? Are you sure humans can tolerate that. I thought minerals are supposed to be taken in low doses.
That’s 3 grams of Ceylon cinnamon + micrograms of chromium. 
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I learned the hard way that a urinalysis will show +1 or +2 glucose if you’re taking Empagliflozin. I was searching all over the internet about it and finally figured out what it was from
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This shows greater effects when taken daily so I don’t see any reason to take it every other day.
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I take 10mg Empa, 40mg Telm, and 5mg Nebivolol and have been for quite some time now.
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UK biobank study (
preprint ) suggesting that SGLT2i (cana, dapa, empa) extend lifespan: First report from Epiterna on the search for drugs that can extend human lifespan
Another paper confirming that empa and dapa are equivalent in T2D: Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus 2024
There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73–2.35; p = 0.349)
Dapagliflozin and empagliflozin showed no significant difference of real‐world clinical cardiovascular outcomes in patients with DM over a 3‐year period.
(if you look at a longer period of time, could dapa be better than empa?)
A potential pro-longevity pathway: SGLT2i improves kidney senescence by down-regulating the expression of LTBP2 in SAMP8 mice 2024
Together, these results reveal dapagliflozin can delay natural kidney senescence in non-diabetes environment; the mechanism may be through regulating the role of LTBP2.
Two reviews of the class:
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Once these start coming off patent I wonder if we will see a meaningful uptake in longevity circles and broader health optimizer world…
… case is building in a nice way
Just wish we could see some rich MR data on longevity for SGLT2i
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They’re already off-patent. But for whatever reason generics haven’t reached the market yet (despite approval in the US: Lupin Receives Tentative Approval for Empagliflozin Tablets - Lupin ).
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