Drug General Information (ID: DDI6SEL9NG)
Drug Name			Empagliflozin		Drug Info		Nitrous acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Antidotes
Structure

Mechanism of Empagliflozin-Nitrous acid Interaction (Severity Level: Moderate)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Empagliflozin				Nitrous acid
Mechanism 1		Antihypertensive agent				Hypotensive effects Guanylate cyclase  Agonist
Key Mechanism Factor 1
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.     Click to Show/Hide
Mechanism Description		Additive hypotensive effects by the combination of Empagliflozin and Nitrous acid
Mechanism 2		Hypotensive effects				Hypotensive effects Guanylate cyclase  Agonist
Key Mechanism Factor 2
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.     Click to Show/Hide
Mechanism Description		Additive hypotensive effects by the combination of Empagliflozin and Nitrous acid

Recommended Action
Management		Caution is advised if SGLT-2 inhibitors are coadministered with diuretics and other hypotensive agents, particularly in the elderly and patients with impaired renal function. Prior to initiating SGLT-2 inhibitors, volume status should be assessed and corrected, if necessary. Clinical and laboratory monitoring are recommended during therapy, including electrolytes, fluid status, renal function, and blood pressure. If volume depletion occurs, treatment with SGLT-2 inhibitors should be interrupted until the condition is corrected.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Product Information. Jardiance (empagliflozin). Boehringer Ingelheim, Ridgefield, CT.