Not for use in patients w/ type 1 diabetes. Caution in patients at higher risk of diabetic ketoacidosis (DKA). Discontinue use in patients w/ suspected or diagnosed DKA; suspected pancreatitis; suspected bullous pemphigoid. Interrupt treatment for major surgical procedures or in acute serious medical illnesses. Monitoring of ketone levels (blood test is preferred to urine test) is recommended in these patients. Treatment w/ empagliflozin may be restarted when ketone values are normal & patient's condition has stabilized. Caution when used in combination w/ a sulfonylurea &/or insulin; dose reduction of sulfonylurea or insulin may be considered. Caution in patients for whom an empagliflozin-induced drop in BP & vol depletion could pose a risk. Carefully monitor vol status & electrolytes. Temporarily interrupt treatment until fluid loss is corrected. Treatment w/ SGLT2 inhibitors increases the risk for UTI; evaluate patients for signs & symptoms of UTI & treat promptly if indicated. Consider discontinuation in cases of recurrent UTI. Regularly examine the feet & counsel all patients on routine preventative footcare. Patients w/ suspected Fournier's Gangrene should immediately start treatment w/ broad-spectrum antibiotics &, if necessary, surgical debridement; discontinue empagliflozin, closely monitor blood glucose levels, & provide appropriate alternative therapy. Consider discontinuation in patients who present w/ or experience an exacerbation of arthralgia during treatment w/ linagliptin. Linagliptin has not been studied in combination w/ GLP-1 analogues. Assess renal function prior to treatment initiation & periodically during treatment; & prior to initiation of concomitant medicines that may reduce renal function & periodically thereafter. Patients treated w/ empagliflozin can experience an initial fall in eGFR. Avoid use during pregnancy & breast-feeding. Not recommended in patients <18 yr. Not recommended to initiate in patients ≥75 yr.
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