Experiences with
Empagliflozin

Empagliflozin is a medicine that's mainly used to treat type 2 diabetes.

Type 2 diabetes is a condition where the body does not make enough insulin, or the insulin that it makes does not work properly. This can cause high blood sugar levels (hyperglycaemia). Empagliflozin works by helping your body to remove extra sugar through your pee.

Your doctor may recommend empagliflozin for treating type 2 diabetes if:

diet and exercise are not enough to control your blood sugar levels
you cannot take metformin (another type of diabetes medicine)

It can also be taken together with other diabetes medicines, such as insulin, if a single diabetes medicine is not controlling your blood sugar properly.

Empagliflozin can also be used to treat:

heart failure – it can reduce the risk of your heart getting weaker, and help symptoms such as tiredness
chronic kidney disease (CKD) – it can help slow the rate at which the condition gets worse

Empagliflozin is only available on prescription. It comes as tablets.

It also comes combined with other diabetes medicines. Brand names include Synjardy (empagliflozin with metformin) and Glyxambi (empagliflozin with linagliptin).

Who can take empagliflozin

Most adults aged 18 years and older can take empagliflozin.

Check with a doctor if you're aged 75 years or older. Some medicines containing empagliflozin are not recommended for older people.

It is not used for treating type 1 diabetes.

Who may not be able to take empagliflozin

Empagliflozin is not suitable for some people. To make sure it's safe for you, tell your doctor before starting to take this medicine if you:

have ever had an allergic reaction to empagliflozin or any other medicine
have high blood sugar (glucose) and ketones (produced when your body breaks down fat) in your pee – there are home tests for this
have severe kidney or liver disease
have low blood pressure
often get urinary tract infections (UTIs)
are due to have surgery
are pregnant, trying to get pregnant or breastfeeding

Taking empagliflozin tablets

Empagliflozin tablets come in strengths of 10mg or 25mg.

The usual starting dose for diabetes is 10mg, taken once a day. Your doctor may increase your dose to 25mg taken once a day.

The usual dose for heart failure or chronic kidney disease is 10mg once a day.

You can take it any time of day, either with or without food. Just try to take it at the same time each day.

Swallow the tablets whole with a drink of water. Do not chew them.

Taking empagliflozin with metformin (Synjardy)

There are 4 different strengths of Synjardy. Each tablet contains 5mg or 12.5mg of empagliflozin and 850mg or 1g of metformin. Your doctor will prescribe the right strength of tablet for you.

The usual dose is 1 tablet, taken twice a day.

Swallow the tablets whole with a drink of water. Do not chew them.

It's a good idea to take your medicine with food. This means the metformin is less likely to upset your stomach.

Taking empagliflozin with linagliptin (Glyxambi)

There are 2 strengths of Glyxambi. Each tablet contains 5mg of linagliptin, and either 10mg or 25mg of empagliflozin.

The usual dose is 1 tablet, taken once a day.

Swallow the tablets whole with a drink of water. Do not chew them.

You can take it any time of day, either with or without food. Just try to take it at the same time each day.

How long to take it for

Treatment for diabetes, heart failure or chronic kidney disease is usually for life. Do not stop taking your empagliflozin tablets without talking to your doctor first.

If you stop taking it suddenly your condition may get worse.

If this medicine is not working for you or you're bothered by side effects, speak to your doctor. They may be able to recommend another medicine to treat your condition.

If you forget to take it

If you miss a dose, what to do depends on which type of tablets you're taking.

If you miss a dose of empagliflozin or empagliflozin with linagliptin (Glyxambi) and it's 12 hours or more until your next dose, take it as soon as you remember. Then take your next dose at the usual time.

If it's less than 12 hours until your next dose, skip the missed dose. Then take your next dose at the usual time.

If you miss a dose of empagliflozin with metformin (Synjardy), take it as soon as you remember, unless it's only a few hours until your next dose. In this case skip the forgotten dose and take your next dose at the usual time.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

An overdose of empagliflozin can cause low blood sugar (hypoglycaemia). Symptoms include feeling hungry, trembling or shaking, sweating, confusion and difficulty concentrating.

If you think you have low blood sugar, have some food or drink that quickly gets sugar into your bloodstream (like sugar cubes or fruit juice).

This type of sugar will not stay in your blood for long. You may also need to eat a starchy carbohydrate, like a sandwich or a couple of biscuits.

you take more than your prescribed dose of empagliflozin

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the empagliflozin packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of empagliflozin happen in more than 1 in 100 people. They're usually mild and do not last long. There are things you can do to help cope with them:

Ask your pharmacist to recommend an antifungal treatment for thrush. Speak to your doctor if it does not work within a week or you get thrush often. There are also things you can do to prevent thrush returning.

These can be signs of a urinary tract infection (UTI). Take paracetamol, and rest and drink plenty of fluids, to help your body flush out the bacteria. Speak to your doctor if symptoms are not better in 2 or 3 days, or if they get worse at any time.

This may be a sign that your medicine is working and you're peeing out more sugar. Drink lots of water, and other sugar-free fluids, to avoid dehydration.

This can also sometimes be a sign of a urinary tract infection (UTI). Speak to your doctor if it does not get better or if you have other UTI symptoms such as pain when you pee.

It may help to take an antihistamine. Check with a pharmacist to see what type is suitable for you. Speak to your doctor if the rash or itching does not go away or gets worse.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Low blood sugar

If you take empagliflozin with other diabetes medicines, including insulin or sulfonylureas like gliclazide, your blood sugar can sometimes go too low. This is called hypoglycaemia or a "hypo".

Early warning signs of low blood sugar include:

feeling hungry
trembling or shaking
sweating
confusion
difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar can happen if you:

take more than your prescribed dose of some types of diabetes medicines
skip meals, have them at unusual times or you're fasting
do not eat a healthy diet and are not getting enough nutrients
change what you eat
increase your physical activity without eating more to compensate
drink alcohol, especially after skipping a meal
take some other medicines or herbal remedies at the same time
have a hormone disorder, such as an underactive thyroid (hypothyroidism)
have kidney or liver problems

It's important to have regular meals, including breakfast, to prevent hypoglycaemia. Never miss or delay a meal.

Always carry a fast-acting carbohydrate with you, like glucose or dextrose tablets, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.

You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

Contact 111 straight away if taking in sugar does not help within 10 to 15 minutes, or the hypo symptoms come back.

Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious side effects

Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is what happens when your body starts to run low on insulin and harmful substances, called ketones, build up in the body. Signs of DKA can include:

feeling or being sick
feeing very thirsty
feeling confused or unusually tired
having stomach pain
breath that smells fruity (like pear drop sweets, or nail varnish)
breathing more deeply or faster

Symptoms usually develop over 24 hours, but can come on faster. Your diabetes team or nurse will show you how to monitor your ketone and blood sugar levels, and what to do if this happens. You'll learn how to recognise the symptoms of DKA and what to do about it.

If you become unwell or need surgery, your doctor may recommend that you stop taking empagliflozin until you've recovered, to reduce the risk of DKA.

Other serious side effects

Tell your doctor or call 111 straight away if:

you're feeling thirsty, have dark yellow and strong-smelling pee, feeling dizzy, light-headed or tired, have a dry mouth, lips and eyes, and you're peeing less often than usual – these can be signs of dehydration
you have a high temperature or feel cold and shivery, get a burning feeling when peeing, have pain in your back, side or tummy, or blood in your urine – these can be signs of a severe urinary tract infection (UTI)
you get severe pain, tenderness, redness, or swelling in the genital area or the skin between your genitals and anus, with a high temperature or feeling unwell – this may be a sign of a serious infection called Fournier's gangrene

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to empagliflozin.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of empagliflozin. For a full list, see the leaflet inside your medicines packet.

Empagliflozin and pregnancy

Empagliflozin is not recommended in pregnancy as there is little information about whether it could affect the baby. Other medicines used to treat diabetes, such as insulin and metformin, are safe to take during pregnancy.

If you take empagliflozin and are pregnant or planning a pregnancy, talk to your doctor. They will need to review your treatment and may suggest different medicine that is more suitable to take in pregnancy.

Empagliflozin and breastfeeding

Empagliflozin is not usually recommended while you're breastfeeding as it's not known how much passes into breast milk, but it's likely to be a small amount.

It's possible that empagliflozin could lower your baby's blood sugar level and could affect the way their kidneys develop and grow, although this has not been proven.

Speak to your doctor about what's best for you and your baby. They will need to review your treatment and may be able to suggest an alternative medicine for you, particularly while you're breastfeeding a newborn or premature baby.

If your doctor says it's OK to take empagliflozin while breastfeeding, talk to your health visitor, midwife, doctor or pharmacist as soon as possible if you have any concerns, including if your baby:

is not feeding as well as usual
is more sleepy or drowsy
is more restless or irritable
seems hungrier or more thirsty
is peeing more than usual

Empagliflozin and fertility

There's no evidence that empagliflozin affects fertility in either men or women.

Speak to your doctor if you're trying to get pregnant as they may want to review your treatment.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may increase the effects of empagliflozin. This can make you more likely to get side effects.

Tell your doctor if you're taking any of these medicines:

medicines that make you pee more (diuretics), such as furosemide – these can increase your risk of dehydration and lower your blood pressure
high blood pressure medicines, such as ramipril or amlodipine
other medicines that can lower your blood pressure – including some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), tamsulosin (for an enlarged prostate), or co-careldopa or levodopa (for Parkinson's disease)
medicines that cause low blood sugar, such as insulin or gliclazide – your doctor may lower your dose of these other medicines to prevent hypos

Taking empagliflozin with painkillers

It's safe to take empagliflozin with everyday painkillers such as paracetamol and ibuprofen.

Mixing empagliflozin with herbal remedies and supplements

There is very little information about taking empagliflozin with herbal remedies and supplements. However, some herbal products such as karela, turmeric and ginseng can potentially cause low blood sugar (hypoglycaemia).

There's not enough information to say that other complementary medicines, supplements and herbal remedies are safe to take with empagliflozin. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert