empagliflozin + metformin at a glance
Medicine class
SGLT2 inhibitor plus biguanide
Licensed use
Type 2 diabetes in adults and children aged 10 years and over
Taking the tablets
Swallow whole with water and take with meals to reduce stomach side effects
Low blood sugar
Risk increases when combined with insulin or a sulphonylurea
What is empagliflozin + metformin used for?
Licensed alongside diet and exercise for type 2 diabetes in adults and children aged 10 years and over.
When the maximum tolerated metformin treatment has not provided sufficient control.
With other diabetes treatments when regimens containing metformin remain insufficient.
To replace separate empagliflozin and metformin tablets in people already taking both components.
How does empagliflozin + metformin work?
Empagliflozin blocks SGLT2 in the kidneys, causing more glucose to leave in urine. Metformin reduces glucose production by the liver, improves insulin sensitivity and modestly delays glucose absorption from the gut. Neither directly stimulates insulin release.
How to take empagliflozin + metformin
Take the tablets exactly as prescribed, with meals. Swallow them whole with water rather than chewing them.
Maintain adequate fluid intake unless a clinician has advised otherwise.
Contact a healthcare professional during illness causing vomiting, diarrhoea, fever or reduced fluid intake because temporary interruption may be necessary.
Tell the clinical team before surgery or imaging involving iodinated contrast.
empagliflozin + metformin side effects
Common or expected effects
- Nausea, vomiting, diarrhoea, abdominal discomfort or reduced appetite, especially when starting treatment
- Genital thrush or another genital infection
- Urinary tract infection
- Increased urination or thirst
- Taste disturbance, constipation, itching or rash
- Reduced vitamin B12 levels
- Low blood sugar when used with insulin or a sulphonylurea
Get urgent medical advice
- Diabetic ketoacidosis, which can occur without markedly raised blood glucose
- Lactic acidosis
- Severe dehydration or low blood pressure
- Kidney infection or urosepsis
- Fournier's gangrene: painful, red or swollen genital or perineal tissue with fever or malaise
- Angioedema or another severe allergic reaction
empagliflozin + metformin in pregnancy
The combination is not recommended during pregnancy because information about empagliflozin is limited, although metformin alone has established pregnancy use. Anyone planning pregnancy or who becomes pregnant should have treatment reviewed promptly.
empagliflozin + metformin while breastfeeding
The fixed combination should not be used while breastfeeding because information about empagliflozin is insufficient and effects on the infant's developing kidneys cannot be excluded. Metformin alone is generally compatible with breastfeeding, so specialist or prescriber review can identify an alternative.
empagliflozin + metformin interactions
Important interactions mainly involve low blood sugar, dehydration, kidney function or metformin accumulation.
Insulin and sulphonylureas
The combination increases the risk of hypoglycaemia, so treatment may need clinical review.
Loop or thiazide diuretics
Additive fluid loss can increase dehydration and low blood pressure.
NSAIDs, ACE inhibitors and angiotensin-II receptor blockers
Medicines that impair kidney function can increase the risk of metformin-associated lactic acidosis, requiring renal monitoring.
Common questions about empagliflozin + metformin
Answers are fully visible for fast scanning and source review.
What is empagliflozin + metformin used for?
Alongside diet and exercise, it improves blood glucose control in people aged 10 years and over with type 2 diabetes when metformin-based treatment is insufficient or both ingredients are already taken separately.
Is it licensed for heart failure or chronic kidney disease?
The fixed combination is licensed for type 2 diabetes, not as a standalone treatment for heart failure or chronic kidney disease. Empagliflozin-only products have separate indications.
Can it cause low blood sugar?
The risk is relatively low by itself but increases when insulin or a sulphonylurea is also used.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.