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Empagliflozin-Induced Liver Injury.

Hélder Diogo Gonçalves1, Inês Parreira1, Sara Vasconcelos-Teixeira1

  • 1Serviço de Medicina Interna, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.

European Journal of Case Reports in Internal Medicine
|December 11, 2025
PubMed
Summary
This summary is machine-generated.

Sodium-glucose cotransporter 2 inhibitors like empagliflozin can rarely cause drug-induced liver injury. Prompt withdrawal of the medication is key for recovery in patients experiencing cholestatic liver damage.

Keywords:
Drug-induced liver injurycholestatic hepatitisempagliflozinidiosyncratic hepatotoxicitysodium-glucose cotransporter 2 inhibitor

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Area of Science:

  • Hepatology
  • Pharmacology
  • Endocrinology

Background:

  • Drug-induced liver injury (DILI) is an uncommon adverse reaction with varied presentations.
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used for type 2 diabetes, generally considered liver-safe.
  • Rare instances of DILI linked to SGLT2 inhibitors necessitate vigilance.

Purpose of the Study:

  • To report a case of cholestatic DILI in a patient treated with empagliflozin.
  • To highlight the importance of systematic evaluation and causality assessment in suspected SGLT2 inhibitor-associated hepatotoxicity.

Main Methods:

  • A 56-year-old male with type 2 diabetes developed cholestatic liver injury after initiating empagliflozin.
  • Diagnostic work-up excluded other causes of liver dysfunction.
  • Causality was assessed using established scoring systems (Roussel Uclaf Causality Assessment Method, Maria and Victorino, Naranjo).
  • Liver biopsy confirmed acute cholestatic injury.

Main Results:

  • The patient presented with jaundice and elevated cholestatic liver enzymes.
  • Empiric exclusion of other liver injury etiologies was performed.
  • Causality assessment indicated a probable link between empagliflozin and liver injury.
  • Liver biopsy findings were consistent with drug-induced cholestatic injury.
  • Discontinuation of empagliflozin led to clinical and biochemical improvement.

Conclusions:

  • Empagliflozin can rarely induce idiosyncratic cholestatic DILI, even in patients with cirrhosis.
  • Early identification, drug withdrawal, and thorough evaluation are crucial for managing SGLT2 inhibitor-associated hepatotoxicity.
  • This case contributes to the understanding of rare SGLT2 inhibitor-induced liver injury.