empagliflozin and metformin

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Pronunciation: EM pa gli FLOE zin and met FOR min

Brand: Synjardy

What is the most important information I should know about empagliflozin and metformin?

You should not use this medicine if you have moderate to severe kidney disease, if you are on dialysis, or diabetic ketoacidosis (call your doctor for treatment). Empagliflozin and metformin is not for treating type 1 diabetes.

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking empagliflozin and metformin.

This medicine may cause a serious condition called lactic acidosis. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

What is empagliflozin and metformin?

Empagliflozin and metformin are oral diabetes medicines that help control blood sugar levels. Empagliflozin works by helping the kidneys get rid of glucose from your bloodstream. Metformin lowers glucose production in the liver and also causes your intestines to absorb less glucose.

Empagliflozin and metformin is a combination medicine used together with diet and exercise to improve blood sugar control in adults with diabetes mellitus.

Empagliflozin and metformin is also used to lower the risk of death from heart attack, stroke, or heart failure in adults with type 2 diabetes who also have heart disease.

This medicine is not for treating type 1 diabetes.

Empagliflozin and metformin may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking empagliflozin and metformin?

You should not use this medicine if you are allergic to empagliflozin (Jardiance, Glyxambi) or metformin (Glucophage, Actoplus Met, Avandamet, Fortamet, Glucovance, Janumet, Jentadueto, Kazano, Kombiglyze, Metaglip, PrandiMet, Riomet), or if you have:

  • moderate to severe kidney disease (or if you are on dialysis); or
  • if you are in a state of diabetic ketoacidosis (call your doctor for treatment).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking empagliflozin and metformin.

Some people taking metformin develop a serious condition called lactic acidosis. This may be more likely if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your risk.

To make sure empagliflozin and metformin is safe for you, tell your doctor if you have:

  • liver or kidney disease;
  • low blood pressure;
  • a history of bladder infections or urination problems;
  • high cholesterol levels;
  • a history of heart attack or stroke;
  • if you are on a low-salt diet;
  • if you take blood pressure medicine such as a diuretic (water pill); or
  • if you are 65 or older and your kidneys have not been tested.

It is not known whether empagliflozin and metformin will harm an unborn baby. Tell your doctor if you are pregnant or if you become pregnant while taking this medicine.

It is not known whether this medicine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking empagliflozin and metformin.

Empagliflozin and metformin is not approved for use by anyone younger than 18 years old.

How should I take empagliflozin and metformin?

Your doctor may perform kidney function tests before you start taking empagliflozin and metformin.

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take this medicine with food to prevent upset stomach.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Your doctor may have you take extra vitamin B12 while you are taking empagliflozin and metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine, which can lead to severely low blood pressure or a serious electrolyte imbalance.

Your blood sugar will need to be checked often, and you may also need to test the level of ketones your urine. Empagliflozin can cause life-threatening ketoacidosis (too much acid in the blood). Even if your blood sugar is normal, contact your doctor if a urine test shows that you have ketones in the urine.

Empagliflozin and metformin can cause positive results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using this medicine.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Empagliflozin and metformin is only part of a complete treatment program that may also include diet, exercise, weight control, regular blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store at room temperature, away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of metformin may cause lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid while taking empagliflozin and metformin?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking this medicine.

What are the possible side effects of empagliflozin and metformin?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Early symptoms of lactic acidosis may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;
  • dehydration symptoms --feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;
  • signs of a kidney problem --little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath;
  • ketoacidosis (too much acid in the blood) --nausea, vomiting, stomach pain, confusion, unusual drowsiness, or trouble breathing;
  • signs of a bladder infection --pain or burning when you urinate, urine that looks cloudy, pain in pelvis or back; or
  • signs of a genital infection (penis or vagina) --pain, burning, itching, rash, redness, odor, or discharge.

Side effects may be more likely to occur in older adults.

Common side effects may include:

  • bladder infection or genital infection;
  • headache;
  • stomach pain, gas, indigestion, nausea, vomiting, diarrhea;
  • weakness; or
  • cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect empagliflozin and metformin?

Sometimes it is not safe to use certain medications at the same time. Certain drugs can increase your risk of lactic acidosis or low blood sugar when used together with empagliflozin and metformin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all medicines you use, and those you start or stop using. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about empagliflozin and metformin.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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