Generic drug: empagliflozin and metformin
Brand name: Synjardy
What is Synjardy (empagliflozin and metformin), and how does it work?
It is not known if Synjardy is safe and effective in children younger than 18 years of age.
What are the side effects of Synjardy?
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment.
Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the full prescribing information.
Synjardy may cause serious side effects including:
- difficulty breathing,
- swelling of your face, lips, tongue, or throat,
- burning or painful urination,
- frequent or urgent urination,
- pink or bloody urine,
- little or no urination,
- unusual vaginal discharge, burning, itching, or odor,
- redness, itching, swelling of the penis,
- unusual discharge from the penis,
- pain, redness, or swelling in or around the genital or anal area,
- feeling unwell,
- sudden sweating,
- fast heartbeat,
- blurred vision,
- tingling hands or feet,
- increased urination,
- rapid breathing,
- fruity breath odor,
- heavy sweating,
- dry mouth,
- lightheadedness, and
Get medical help right away, if you have any of the symptoms listed above.
The most common side effects of Synjardy include:
Tell the doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Synjardy. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is the dosage for Synjardy?
Prior To Initiation Of Synjardy
- Assess renal function before initiating Synjardy and as clinically indicated.
- In patients with volume depletion, correct this condition before initiating Synjardy.
Recommended Dosage And Administration
- Individualize the starting dose of Synjardy based on the patient’s current regimen:
- In patients on metformin HCl, switch to Synjardy containing empagliflozin 5 mg with a similar total daily dose of metformin HCl;
- In patients on empagliflozin, switch to Synjardy containing metformin HCl 500 mg with a similar total daily dose of empagliflozin;
- In patients already treated with empagliflozin and metformin HCl, switch to Synjardy containing the same total daily doses of each component.
- Monitor effectiveness and tolerability, and adjust dosing as appropriate, not to exceed the maximum recommended daily dose of empagliflozin 25 mg and metformin HCl 2000 mg.
- Take Synjardy twice daily with meals; with gradual dose escalation to reduce the gastrointestinal side effects due to metformin.
Dosage Recommendations In Patients With Renal Impairment
- Initiation of Synjardy is not recommended in patients with an eGFR less than 45 mL/min/1.73 m2, due to the metformin component.
- Synjardy is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m2 or in patients on dialysis.
Discontinuation For Iodinated Contrast Imaging Procedures
Discontinue Synjardy at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR less than 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart Synjardy if renal function is stable.
What drugs interact with Synjardy?
Table 4 Clinically Relevant Interactions with Synjardy
|Carbonic Anhydrase Inhibitors|
|Clinical Impact||Topiramate or other carbonic anhydrase inhibitors (e.g., zonisamide, acetazolamide or dichlorphenamide) frequently causes a decrease in serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis.|
|Intervention||Concomitant use of these drugs with Synjardy may increase the risk of lactic acidosis. Consider more frequent monitoring of these patients.|
|Drugs that Reduce Metformin Clearance|
|Clinical Impact||Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis.|
|Intervention||Consider the benefits and risks of concomitant use.|
|Clinical Impact||Alcohol is known to potentiate the effect of metformin on lactate metabolism.|
|Intervention||Warn patients against excessive alcohol intake while receiving Synjardy.|
|Clinical Impact||Coadministration of empagliflozin with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.|
|Intervention||Before initiating Synjardy, assess volume status and renal function. In patients with volume depletion, correct this condition before initiating Synjardy. Monitor for signs and symptoms of volume depletion, and renal function after initiating therapy.|
|Insulin or Insulin Secretagogues|
|Clinical Impact||The risk of hypoglycemia is increased when empagliflozin is used in combination with insulin secretagogues (e.g., sulfonylurea) or insulin. Metformin may increase the risk of hypoglycemia when combined with insulin and/or an insulin secretagogue.|
|Intervention||Coadministration of Synjardy with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.|
|Drugs Affecting Glycemic Control|
|Clinical Impact||Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid.|
|Intervention||When such drugs are administered to a patient receiving Synjardy, the patient should be closely observed to maintain adequate glycemic control. When such drugs are withdrawn from a patient receiving Synjardy, the patient should be observed closely for hypoglycemia.|
|Positive Urine Glucose Test|
|Clinical Impact||SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests.|
|Intervention||Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.|
|Interference with 1,5-anhydroglucitol (1,5-AG) Assay|
|Clinical Impact||Measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors.|
|Intervention||Monitoring glycemic control with 1,5-AG assay is not recommended. Use alternative methods to monitor glycemic control.|
Is Synjardy safe to use while pregnant or breastfeeding?
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Synjardy (empagliflozin and metformin) is a prescription medicine used to treat the symptoms of Type 2 Diabetes Mellitus. Serious side effects of Synjardy include lactic acidosis, hives, difficulty breathing, swelling of your face, lips, tongue, or throat; burning or painful urination, frequent or urgent urination, pink or bloody urine, little or no urination, unusual vaginal or penis discharge, and others.
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People with diabetes can manage and prevent low or high blood sugar levels (hyperglycemia or hypoglycemia) by keeping a log of your blood sugar levels when you are eating and fasting and eat foods that are high in carbohydrates and sugar, for example, buttered potatoes, candy, sugary desserts, and fatty foods. Blood tests, for example, the hemoglobin A1c test (A1c test) and urinalysis can diagnose the type of diabetes the person has. Diabetes during pregnancy, called gestational diabetes, should be managed by you and your OB/GYN or another healthcare professional. Extremely high levels of blood glucose in the blood can be dangerous and life threatening if you have type 1, type 2, or gestational diabetes. If you or someone that you are with has extremely high blood glucose levels, call 911 or go to your nearest Urgent Care or Emergency Department immediately. To prevent and manage high blood glucose levels in people with diabetes keep a log of your blood sugar levels, eat foods that are high in carbohydrates sugar, for example, buttered potatoes, candy, sugary deserts, and fatty foods that you can share with your doctor and other healthcare professionals.
Diabetes (Type 1 and Type 2)
Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Diabetes Symptoms in Men
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Type 2 Diabetes Diet Plan
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.
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Type 1 vs. Type 2 Diabetes: Differences
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Can Diabetes Make My Legs Hurt?
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Is Diabetes A Lifestyle Choice
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Which Country Has the Highest Diabetes Rate?
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Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
What Are the 3 Most Common Symptoms of Undiagnosed Diabetes?
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Is Quinoa Good for Diabetes?
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Can Type 2 Diabetes be Cured?
Type 2 diabetes is a long-term medical condition in which the body is not able to regulate blood sugar (glucose) level because of the inability of the body to properly use insulin. An individual can get type 2 diabetes because of a number of factors that reduce insulin action or quantity in the body. The goals of diabetes management are to eliminate symptoms and prevent the development of complications. Many drugs, both oral and injectable, are available for diabetes management.
What Population Is Most Affected by Diabetes?
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How and Why Does Ethnicity Affect Diabetes?
Diabetes is a condition that causes elevated blood sugar levels. Acquired risk factors are associated with diabetes although ethnicity plays a role in increasing the incidence of the condition.
Is Diabetes Insipidus Life-Threatening?
Diabetes insipidus (DI) is an uncommon disease that manifests as a frequent urge for urination and extreme thirst. It has nothing to do with blood sugar levels. Although in both diabetes mellitus and insipidus, patients experience a large volume of urine production, the cause is completely different.
Tips for Managing Type 1 and 2 Diabetes at Home
Managing your diabetes is a full time commitment. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information will enable you to mange your diabetes at home successfully.
Do Certain Ethnic Groups Have a Higher Risk of Diabetes?
One out of every 10 people in the United States has diabetes. Pacific Islanders, Alaskan natives and American Indians have the highest prevalence rates of diabetes among groups studied in the United States Census.
What Are the Early Signs of Type 2 Diabetes?
Type 2 Diabetes is a chronic disease characterized by increased blood sugar (glucose) level. Type 2 Diabetes is caused by either insufficient insulin secretion or resistance to that hormone’s action. Insulin is produced by the pancreas and helps process the glucose in the blood. Thus, with inadequate insulin, the bodies can’t burn all the blood sugar for energy in an efficient way. This means the glucose level in the blood rises, causing a variety of symptoms and when severe may even lead to death.
Treatment & Diagnosis
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