Empagliflozin Metformin Brand Name– Synjardy | Synjardy XR
What is Empagliflozin Metformin
Empagliflozin metformin is a combination of 2 oral antidiabetic agents. Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Metformin is a biguanide agent that improves insulin sensitivity.
The product is used to improve glycemic control in adults with type 2 diabetes mellitus (DM) who are inadequately controlled on either drug alone or are already receiving both drugs. Empagliflozin has been shown to reduce cardiovascular (CV) risk.
Empagliflozin significantly reduced the risk of major adverse cardiovascular events (MACE: CV death, the first occurrence of non-fatal myocardial infarction, or non-fatal stroke) by 14% relative to placebo (HR 0.86, 95% CI 0.74 to 0.99).
Results from the study supported the FDA approval of empagliflozin to reduce the risk of CV death in adult patients with type 2 DM and CV disease; however, empagliflozin; metformin is not approved for this indication.
Empagliflozin also significantly reduced the risk of hospitalization for heart failure (HF) compared with placebo.
Empagliflozin; metformin should not be used in patients with severe renal impairment as empagliflozin efficacy is reduced, and the risk of metformin-related lactic acidosis is increased.
Metformin is first-line in the treatment of type 2 DM. Additional therapy with an SGLT2 inhibitor with evidence of reducing HF and/or chronic kidney disease (CKD) progression should be considered in patients with indicators of high-risk or established CKD or HF, independent of baseline A1C or individualized A1C target.
SGLT2 inhibitors with proven CV-risk reduction, like empagliflozin, are also an alternative treatment option in DM patients with indicators of high-risk or established CV disease who cannot tolerate a glucagon-like peptide-1 receptor agonist (GLP-1 RA).
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus in combination with diet and exercise when treatment with both empagliflozin and metformin is appropriate
Side Effects
- abdominal pain
- angioedema
- anorexia
- arthralgia
- asthenia
- balanitis
- candidiasis
- cholestasis
- cystitis
- dehydration
- diabetic ketoacidosis
- diarrhea
- diuresis
- dysgeusia
- dyspepsia
- elevated hepatic enzymes
- flatulence
- folate deficiency
- headache
- hypercholesterolemia
- hyperlipidemia
- hypoglycemia
- hypotension
- hypovolemia
- increased urinary frequency
- infection
- lactic acidosis
- malaise
- megaloblastic anemia
- metabolic acidosis
- metallic taste
- myalgia
- nausea
- necrotizing fasciitis
- nocturia
- orthostatic hypotension
- pharyngitis
- phimosis
- polydipsia
- polyuria
- pyrosis (heartburn)
- rash
- renal failure (unspecified)
- rhabdomyolysis
- syncope
- tissue necrosis
- urticaria
- vaginitis
- vitamin B12 deficiency
- vomiting
Monitoring Parameters
- blood glucose
- CBC
- glycosylated hemoglobin A1c (HbA1c)
- serum cholesterol profile
- serum creatinine/BUN
- serum electrolytes
Contraindications
- acidemia
- acute heart failure
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- balanitis
- breast-feeding
- burns
- cardiac disease
- cardiogenic shock
- children
- dehydration
- diabetic ketoacidosis
- dialysis
- diarrhea
- ethanol ingestion
- ethanol intoxication
- fever
- gastroparesis
- geriatric
- GI obstruction
- heart failure
- hepatic disease
- history of angioedema
- hypercholesterolemia
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypotension
- hypovolemia
- hypoxemia
- ileus
- infants
- infection
- lactic acidosis
- malnutrition
- metabolic acidosis
- pernicious anemia
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- pyelonephritis
- radiographic contrast administration
- renal disease
- renal failure
- renal impairment
- sepsis
- surgery
- tissue necrosis
- trauma
- type 1 diabetes mellitus
- urinary tract infection (UTI)
- vaginitis
- vomiting
Interactions
- Abacavir; Dolutegravir; Lamivudine
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