Positives

• Patients on empagliflozin were 20 to 40% more likely to improve their NYHA functional class and 20 to 40% less likely to worsen, regardless of ejection fraction NEJM.
  
  
• A meta-analysis of about 12,000 patients across 16 RCTs found no increase in orthostatic hypotension on SGLT2 inhibitors, an important reassurance for those worried about post-COVID dysautonomia overlap SAGE Journals.
  
  

Negatives

• A patient described constant lightheadedness and falls along with thirst and frequent urination on Jardiance Drugs.com.
  
  
• Several women reported recurrent yeast infections severe enough that they had to discontinue empagliflozin entirely Drugs.com.
  
  

Hurdles & Side Effects

• Volume depletion from osmotic diuresis can worsen orthostatic symptoms in patients who are also salt-loading and compression-stockinged for POTS Cleveland Clinic Journal of Medicine.
  
  
• Patients on empagliflozin face a small but real risk of euglycemic diabetic ketoacidosis, requiring sick-day rules and education that primary-care visits often skip Cleveland Clinic Journal of Medicine.