Camzyos
Camzyos
Generic Name
Camzyos
Mechanism
- Selective SGLT2 blockade in the proximal renal tubule → ↓ glucose reabsorption
- Leads to increased glycosuria (glucose excretion) and a modest caloric loss
- Results in lower fasting and post‑prandial glucose, reduced HbA1c, modest weight loss, and modest blood‑pressure reduction
Pharmacokinetics
- Oral; peak plasma concentration 1–2 h post‑dose
- Bioavailability: ~65‑70 %, first‑pass metabolism via CYP3A4
- Protein binding: ~45 %
- Half‑life: 12–18 h → once‑daily dosing
- Elimination: Renal (≈44 %) and fecal (≈39 %)
- Renal adjustment: No starting‑dose reduction for eGFR ≥ 30 mL/min/1.73 m²; dose may be reduced if eGFR falls < 30 mL/min/1.73 m²
Indications
- Adjunct to diet and exercise in adults with T2DM
- Reduction of CV mortality and hospitalization for heart failure in T2DM + established CV disease
- Adjunct therapy for type 1 diabetes (in selected patients)
- FDA: Approved for T2DM; EMA also recommends for certain heart‑failure patients
Contraindications
- Absolute contraindication: Hypersensitivity to empagliflozin or any excipient
- Renal disease: eGFR < 20 mL/min/1.73 m² (no recommendation)
- Pregnancy: Category D – avoid; not recommended for lactation
- Active genital or urinary tract infections: ↑ risk
- Diabetic ketoacidosis (DKA): monitor for symptoms, especially post‑operatively or in fasting states
- Volume depletion: caution in elderly, low‑volume states, or concurrent diuretic therapy
- Amputation risk: monitor foot health; reduce exposure in patients with risk factors
Dosing
| Indication | Dose | Titration | Renal Guidance |
| T2DM | 10 mg once daily | If HbA1c > 0.5 % after 3 mo → 25 mg | eGFR ≥ 30 mL/min/1.73 m²: 25 mg permissible; < 30 → 10 mg |
| T1DM adjunct | 10 mg once daily | – | Same renal adjustment |
• Take morning, with or without food
• Do not exceed 25 mg/day
• In elderly or volume‑depleted patients, start lower (10 mg)
Adverse Effects
- Common: genital mycotic infections, urinary tract infections, dysuria, increased urination, mild GI upset (nausea, diarrhea)
- Serious:
- DKA (especially with low-carb diets, illness, or surgery)
- Hypotension/orthostatic hypotension → syncope risk
- Hyperkalemia (in CKD)
- Amputation (class effect): monitor foot health
- Bone fracture (short‑term data)
Monitoring
- HbA1c every 3 months
- Fasting plasma glucose (weekly during titration)
- Weight, blood pressure (pre‑ and post‑dose)
- Renal function (eGFR) at baseline, 3 mo, then 6 mo
- Electrolytes (especially K⁺) in CKD
- Urinalysis for proteinuria if clinically warranted
- Ketone bodies (blood/urine) if symptoms of DKA develop
- Foot examination at each visit
Clinical Pearls
- Early CV benefit: Reductions in mortality observed within 6 weeks; keep patients on therapy regardless of HbA1c change in high‑risk individuals.
- Weight & BP synergy: Even in normoglycemic patients, empagliflozin lowers systolic BP by ~2–3 mmHg and weight by ~1–2 kg over 6 months.
- Renal protection: Empagliflozin slows eGFR decline by ~2–4 mL/min/1.73 m²/year in CKD stage 3 (eGFR ≥30) – consider early initiation.
- Combination safety: Use with GLP‑1 agonists is safe and may provide additive glycemic control without significant hypoglycemia.
- Ketosis vigilance: Educate patients on ketone testing if they experience fatigue, nausea, or flu‑like symptoms.
- Pregnancy caution: Wash hands after handling tablets; avoid use during pregnancy and breastfeeding.
Key take‑away: Camzyos (empagliflozin) offers a multifaceted benefit—glycemic control, CV risk reduction, weight loss, and renal protection—making it a cornerstone of modern diabetes management.