A 58-year-old woman with type 2 diabetes and hypertension develops abdominal pain, dysuria, nocturia, and hematuria. She takes multiple meds including empagliflozin. Which medication is most likely responsible for these urinary symptoms?

A 58-year-old woman with type 2 diabetes and hypertension develops abdominal pain, dysuria, nocturia, and hematuria. She takes multiple meds including empagliflozin. Which medication is most likely responsible for these urinary symptoms?

• A. Alendronic acid
• B. Amlodipine
• C. Empagliflozin
• D. Metformin

Answer: (C)

The urinary symptoms are best explained by an SGLT2 inhibitor. Empagliflozin blocks glucose reabsorption in the proximal tubule, so glucose spills into the urine (glucosuria). That glucose in the urine pulls water with it, causing osmotic diuresis and increased urination, which can manifest as nocturia and dysuria; glucosuria also raises the risk of urinary tract infections, which can cause pain and sometimes hematuria. The other medications listed do not typically produce this pattern of urinary symptoms (bisphosphonates may cause GI irritation or jaw issues, calcium channel blockers more commonly cause edema, and metformin commonly causes GI upset).

The urinary symptoms are best explained by an SGLT2 inhibitor. Empagliflozin blocks glucose reabsorption in the proximal tubule, so glucose spills into the urine (glucosuria). That glucose in the urine pulls water with it, causing osmotic diuresis and increased urination, which can manifest as nocturia and dysuria; glucosuria also raises the risk of urinary tract infections, which can cause pain and sometimes hematuria. The other medications listed do not typically produce this pattern of urinary symptoms (bisphosphonates may cause GI irritation or jaw issues, calcium channel blockers more commonly cause edema, and metformin commonly causes GI upset).