Pharmacology
Empagliflozin is an inhibitor of Sodium-glucose co-transporter 2 (SGL T2). SGL T2 is the perdominant transporter responsible for reabsorption of glucose from the kidney back into the circulation. By inhibiting SGL T2, Empagliflozin reduces renal reabsorption of filtered glucose and lowers the renal threshold for glucose, and thereby increases urinary glucose excretion.

Indication
D-Fozin is indicated
-as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus and
- to reduce the risk of cardiovascular death in adult patinets with type 2 diabetes mellitus and established cardiovascular disease

Dosage and Administration
The recommended dose of D-Fozin is 10 mg once daily, taken in the morning, with or without food. In patients tolerating Empagliflozin, the dose may be increased to 25 mg once daily. In patients with volume depletion, correcting this condition prior to initiation of Empagliflozin is recommended.

Contraindication
Empagliflozin is contraindicated in patinets with history of serious hypersensitivity reaction of Empagliflozin or any of its ingredients, severe renal impairment, end-stage renal disease, or dialysis.

Warning and Precaution
Assessment of renal function is recommended prior to initiation of Empagliflozin and periodically thereafter. Empagliflozin should not initiated in patients with an eGFR less then 45 mL/min/1.73m2. No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1.73m2.
The risk or necrotizing fasciitis of the perineum/Fournier’s gangrene is very rare. Consult with doctor immediately if you experience any symptoms of tenderness, redness or swelling of the genitals or the area form the genitals back to the rectum and have a fever above 100.40F.

Side Effect
The most common adverse reactions associated with Empagliflozin are urinary tract infections and female genital mycotic infections. Others common side effects includes dehydration, hypotension, weakness, dizziness and increased thirstiness.

Use in Pregnancy and Lactation
There are no adequate and well-controlled studies of Empagliflozin in pregnant women. Empagliflozin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known if Empagliflozin is excreted in human milk. It is not recommended when breastfeeding.

Drug Interaction
Diuretics: Co-administration of Empagliflozin with diuretics resulted in increased urine volume.
Insulin or Insulin Secretagogues: Co-administration of Empagliflozin with insulin or insulin secretagogues increases the risk for hypoglycemia.
Positive Urine Glucose Test: Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGL T2 inhibitors as SGL T2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests. Use alternative methods to monitor glycemic control
Interference with 1, 5-anhydroglucitol (1, 5-AG) Assay: Monitoring glycemic control with 1, 5-AG assay is not recommended as measurements of 1, 5-AG are unreliable in assessing glycemic control in patients taking SGL T2 inhibitors. Use alternative methods to monitor glycemic control.

Overdose
In the event of an overdose with D-Fozin, the usual supportive measures (e.g., remove unabsorbed material from the gastrointestinal tract, perform clinical monitoring, and institute supportive treatment) should be employed. The removal of Empagliflozin by hemodialysis has not been studied.

Storage Condition
Keep in a cool & dry place (below 300C), protected from light & moisture. Keep out of the reach of children.

How Supplied
D-Fozin 25 : Each box contains 2×10’s tablets in Alu-Alu Blister pack.