Empagliflozin and metformin (Oral)
em-pa-gli-FLOE-zin, met-FOR-min hye-droe-KLOR-ide
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio, and metformin plasma levels generally greater than 5 mcg/mL. Risk factors include renal impairment, concomitant use of certain drugs (eg, carbonic anhydrase inhibitors such as topiramate), age 65 years or older, radiological study with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. If lactic acidosis is suspected, discontinue empagliflozin/metformin hydrochloride and institute general supportive measures in a hospital setting .
Medically reviewed on June 7, 2018
Commonly used brand name(s)
In the U.S.
- Synjardy XR
Available Dosage Forms:
- Tablet, Extended Release
Therapeutic Class: Antidiabetic
Pharmacologic Class: Sodium Glucose Co-Transporter 2 Inhibitor
Chemical Class: Metformin
Uses For This Medicine
Empagliflozin and metformin combination is used with proper diet and exercise to treat high blood sugar levels caused by type 2 diabetes. It is also used to lower the risk of death in patients with type 2 diabetes and heart or blood vessel disease.
Empagliflozin works in the kidney to prevent absorption of glucose (blood sugar). This helps lower the blood sugar level. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. It does not help patients who have insulin-dependent or type 1 diabetes. Type 1 diabetic patients must use insulin injections.
Empagliflozin and metformin is available only with your doctor's prescription.
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For empagliflozin and metformin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to empagliflozin and metformin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of empagliflozin and metformin combination in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of empagliflozin and metformin combination in the elderly. However, elderly patients are more likely to have kidney problems, which may require caution and an adjustment in the dose for patients receiving empagliflozin and metformin combination.
Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using empagliflozin and metformin.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking empagliflozin and metformin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using empagliflozin and metformin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Acetrizoic Acid
- Ethiodized Oil
- Iobenzamic Acid
- Iocarmic Acid
- Iocetamic Acid
- Iodohippuric Acid
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iopanoic Acid
- Iopronic Acid
- Ioseric Acid
- Iotroxic Acid
- Ioxitalamic Acid
- Metrizoic Acid
- Tyropanoate Sodium
Using empagliflozin and metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Thioctic Acid
Using empagliflozin and metformin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bitter Melon
- Guar Gum
- Methylene Blue
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of empagliflozin and metformin. Make sure you tell your doctor if you have any other medical problems, especially:
- Adrenal gland problem (underactive) or
- Alcohol abuse, history of or
- Cardiovascular collapse (shock) or
- Congestive heart failure or
- Dehydration, severe or
- Heart attack, acute or
- Pancreatic insulin deficiency, history of or
- Pituitary gland problem (underactive) or
- Poorly nourished condition or
- Sepsis (severe infection) or
- Weakened physical condition—Use with caution. May cause side effects to become worse.
- Anemia (low red blood cells) or
- Dehydration or
- Genital yeast (fungus) infection (eg, balanitis, balanoposthitis, vulvovaginitis), history of or
- Hypercholesteremia (high levels of cholesterol) or
- Hypotension (low blood pressure) or
- Hypovolemia (low blood volume) or
- Kidney disease or
- Urinary tract infections (eg, pyelonephritis, urosepsis), history of or
- Vitamin B12 deficiency—Use with caution. May make these conditions worse.
- Diabetic ketoacidosis (high ketones and acid in the blood) or
- Kidney disease, moderate to severe or
- Liver disease or
- Metabolic acidosis (acid in the blood) or
- Patients receiving dialysis or
- Type I diabetes—Should not be used in patients with these conditions.
- Fever or
- Infection or
- Surgery or
- Trauma—Use with caution. These conditions may cause problems with blood sugar control.
Proper Use of This Medicine
Carefully follow the special meal plan your doctor gave you. This is the most important part of controlling your diabetes, and will help the medicine work properly. Exercise regularly and test for sugar in your blood or urine as directed.
Empagliflozin and metformin should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
Empagliflozin and metformin should be taken with meals to help reduce unwanted stomach effects that may occur during the first few weeks.
Swallow the tablet whole. Do not crush, break, or chew it.
The dose of empagliflozin and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of empagliflozin and metformin. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For type 2 diabetes:
- For oral dosage form (extended-release tablets)
- Adults—At first, 1 or 2 tablets a day with food. Your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 1 tablet of 10 or 25 mg of empagliflozin and 1000 mg of metformin once a day, or 2 tablets of 5 mg or 12.5 mg of empagliflozin and 1000 mg of metformin once a day.
- Children—Use and dose must be determined by your doctor.
- For oral dosage form (tablets)
- Adults—At first, 1 tablet two times a day with food. Your doctor may increase your dose as needed as tolerated. However, the dose is usually not more than 12.5 mg of empagliflozin and 1000 mg of metformin two times a day.
- Children—Use and dose must be determined by your doctor.
- For oral dosage form (extended-release tablets)
If you miss a dose of empagliflozin and metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using This Medicine
It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take empagliflozin and metformin. Blood and urine tests may be needed to check for unwanted effects.
Under certain conditions, too much metformin can cause a serious condition called lactic acidosis. Lactic acidosis usually occurs when other serious health problems are present, such as a heart attack or kidney failure. The symptoms of lactic acidosis include: abdominal or stomach discomfort, decreased appetite, diarrhea, fast or shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness. If you have more than one of these symptoms together, you should get immediate emergency medical help.
Dizziness, lightheadedness, or fainting may occur with empagliflozin and metformin. This is more common if you have kidney disease, low blood pressure, or if you are taking a diuretic (water pill). Taking plenty of fluids each day may help. Drink plenty of water during exercise or in hot weather. Check with your doctor if you have severe nausea, vomiting, or diarrhea that does not stop. This may cause you to lose too much water.
Ketoacidosis (high ketones and acid in the blood) may occur while you are using empagliflozin and metformin. This can be life-threatening and requires immediate medical attention. Your doctor may give you insulin, fluid, and carbohydrate replacement to treat this condition. Tell your doctor right away if you have nausea, vomiting, trouble breathing, increased thirst or urination.
Tell your doctor if you have bloody urine, decrease in how much or how often you urinate, painful or difficult urination, lower back or side pain, fever, chills, or swelling of the face, finger, or lower legs. These may be symptoms of a serious kidney problem.
Let your doctor or dentist know you are taking empagliflozin and metformin. Your doctor may advise you to stop taking empagliflozin and metformin before you have major surgery or diagnostic tests, especially tests that use a contrast dye.
Make sure any doctor or dentist who treats you knows that you are using empagliflozin and metformin. Empagliflozin and metformin may affect the results of certain medical tests (eg, urine glucose tests may not be accurate).
Empagliflozin and metformin can cause hypoglycemia (low blood sugar). However, low blood sugar can occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, cannot eat because of nausea or vomiting, or take certain medicines. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. Talk to your doctor about the best way to treat low blood sugar.
Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your diabetes medicine, overeat or do not follow your diet plan, have a fever or infection, or do not exercise as much as usual. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar.
Empagliflozin and metformin may cause vaginal yeast infections in women and yeast infections of the penis in men. This is more common in patients who have a history of genital yeast infections or in men who are not circumcised. Women may have a vaginal discharge, itching, or odor. Men may have redness, itching, swelling, or pain around the penis, or a discharge with a strong odor from the penis. Check with your doctor right away if you have any of these symptoms.
Empagliflozin and metformin may increase your risk of having urinary tract infections, including pyelonephritis or urosepsis. Check with your doctor right away if you have bladder pain, bloody or cloudy urine, difficult, burning, or painful urination, or lower back or side pain.
Empagliflozin and metformin may cause some women who do not have regular monthly periods to ovulate. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.
Empagliflozin and metformin may make you dizzy. Do not drive or do anything else that could be dangerous until you know how empagliflozin and metformin affects you. Stand up slowly if you feel dizzy.
Limit the amount of alcohol you drink while you are using empagliflozin and metformin. Heavy alcohol use can increase your chances of serious side effects.
There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes with a list of all your medicines.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
This Medicine Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
- Bladder pain
- bloody or cloudy urine
- blurred vision
- cool, pale skin
- decreased appetite
- difficult, burning, or painful urination
- fast heartbeat
- fast, shallow breathing
- feeling sad or empty
- frequent urge to urinate
- general feeling of discomfort
- increased hunger
- lack of appetite
- loss of consciousness
- loss of interest or pleasure
- lower back or side pain
- muscle pain or cramping
- slurred speech
- stomach discomfort
- trouble concentrating
- trouble sleeping
- unusual tiredness or weakness
- Bad-smelling discharge from the penis
- itching of the vagina or genitals
- itching, stinging, or redness of the vaginal area
- redness, itching, swelling, or pain of the penis
- thick, white vaginal discharge with mild or no odor
Incidence not known
- Dark-colored urine
- decreased frequency or amount of urine
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- dry mouth
- flushed, dry skin
- fruit-like breath odor
- increased thirst
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- light-colored stools
- stomach pain, continuing
- unexplained weight loss
- weight gain
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Bloated or feeling of fullness
- excess air or gas in stomach or intestines
- passing gas
- stomach discomfort
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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