1. About empagliflozin
Empagliflozin is a medicine 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).
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 is only available on prescription. It comes as tablets.
2. Key facts
- You'll usually take empagliflozin once a day.
- Empagliflozin works by increasing the amount of sugar that leaves your body in your pee.
- If you're taking empaglifozin with other diabetes medicines, it can sometimes cause low blood sugar (hypoglycaemia). It's a good idea to carry some sweets or fruit juice with you in case this happens.
- Unlike some diabetes medicines, empagliflozin does not make you put on weight. In fact, some people find they lose weight.
- Empagliflozin also comes combined with other diabetes medicines. Brand names include Synjardy (empagliflozin with metformin) and Glyxambi (empagliflozin with linagliptin).
3. Who can and cannot take empagliflozin
Empagliflozin is only for adults (from 18 years). It is not recommended for anyone aged 85 years or older.
It is not used for treating type 1 diabetes.
Empagliflozin is not suitable for some people. Tell your doctor before starting the medicine if you:
- have had an allergic reaction to empagliflozin or any other medicines in the past
- have 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 a heart condition
- often get urinary tract infections (UTIs)
- are due to have surgery
- are pregnant, trying to get pregnant or breastfeeding
4. How and when to take it
Always follow the instructions from your doctor.
Swallow the tablets whole with a drink of water. Do not chew them.
Taking empagliflozin tablets
The usual starting dose for empagliflozin is 10mg. Your doctor may increase your dose to 25mg.
The usual dose is 1 tablet, taken 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.
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. It's a good idea to take your medicine with a meal. 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 the amount of empagliflozin is either 10mg or 25mg.
The usual dose is 1 tablet, taken 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.
What if I forget to take it?
Empagliflozin, or empagliflozin with linagliptin (Glyxambi)
If you miss a dose of empagliflozin or 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 is less than 12 hours until your next dose, skip the missed dose. Then take your next dose at the usual time.
Empagliflozin with metformin (Synjardy)
If you miss a dose of Synjardy, take it as soon as you remember, unless it's only a few hours until your next dose. In which case miss out the forgotten dose and take your next dose at the usual time.
Do not take a double dose to make up for a forgotten 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.
What if I take too much?
Non-urgent advice: Contact your doctor immediately if:
- you take too many empagliflozin tablets
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.
5. Side effects
Like all medicines, empagliflozin can cause side effects although not everyone gets them.
Side effects often improve as your body gets used to the medicine.
Common side effects
These common side effects happen in more than 1 in 100 people. They’re usually mild and shortlived.
Talk to your doctor or pharmacist if these side effects bother you or do not go away:
- pain or a burning feeling when you pee
- peeing more than normal
- mild skin rash or itchy skin
Serious side effects
Most serious side effects are rare and happen in less than 1 in 1,000 people.
Tell your doctor straight away if:
- you're feeling or being sick, feel very thirsty, confused or unusually tired, have stomach pain, your breath smells fruity, and your breathing is deep or fast – these can be signs of diabetic ketoacidosis
- you're feeling thirsty, have dark yellow and strong-smelling pee, feeling dizzy, lightheaded or tired, have a dry mouth, lips and eyes, and you're peeing little, and fewer than 4 times a day – 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 or side, or blood in your urine – these can be signs of a severe urinary tract infection (UTI)
Low blood sugar
If you take empagliflozin with other diabetes medicines, including insulin or sulphonylureas like gliclazide, your blood sugar can sometimes go too low.
This is called hypoglycaemia or a "hypo".
Always carry a fast-acting carbohydrate with you, like sugar cubes, 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.
If taking in sugar does not help within 10 to 15 minutes, or the hypo symptoms come back, contact your doctor or the nearest hospital.
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 allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to empagliflozin.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of empagliflozin. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- thrush – 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.
- pain or a burning feeling when you pee – these can be signs of a urinary tract infection (UTI). Take paracetamol, and rest and drink plenty of fluids – fluids 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.
- peeing more than normal – this is a sign that your medicine is working and you're peeing out more sugar in your urine. Drink lots of water, and other sugar-free fluids, to avoid dehydration. If this side effect bothers you, talk to your doctor or pharmacist.
- mild skin rash or itchy skin – 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.
7. Pregnancy and breastfeeding
Empagliflozin and pregnancy
Empagliflozin is not generally recommended in pregnancy. It is not clear whether empagliflozin can harm an unborn baby.
For safety, your doctor will probably change your medicine to insulin if you're trying for a baby, or as soon as you find out you're pregnant.
Empagliflozin and breastfeeding
It's generally not recommended to take empagliflozin while breastfeeding.
We do not know for certain whether empagliflozin gets into breast milk. But it's possible that empagliflozin can affect the way a baby's kidneys develop and grow.
Speak to your doctor about what's best for you and your baby. They may prescribe a different medicine, particularly while you're breastfeeding a newborn or premature baby.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. 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 are taking any of these medicines:
- medicines that make you pee more (diuretics), like furosemide – these can increase your risk of dehydration and lower your blood pressure
- high blood pressure medicines
- 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
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 sugars (hypoglycaemia)
It is best to check with your doctor or a pharmacist before taking any herbal remedies or supplements while taking empagliflozin.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does it work?
Empagliflozin is a type of medicine known as a sodium-glucose co-transporter-2 (SGLT2) inhibitor.
It reduces blood sugar levels in people with diabetes.
It does this by helping remove excess sugar from your body through your pee.
How long does it take to work?
Empagliflozin starts to work straight away to reduce your blood glucose levels, but it may take a week for it to take full effect.
You may not have had any symptoms of diabetes, so you will not necessarily feel any different when you take empagliflozin. This does not mean that empagliflozin is not working, so it's important to keep taking it.
Empagliflozin will help keep your blood sugar level stable and reduce your chances of diabetes-related problems in the future.
How long will I take it for?
Treatment for diabetes is usually for life. Do not stop taking your empagliflozin tablets without talking to your doctor first.
Is it safe to take for a long time?
Empagliflozin is safe to take for a long time. There is no evidence that this medicine harms your general health.
Can I come off empagliflozin?
Do not stop taking empagliflozin without talking to your doctor first. If you stop taking empagliflozin suddenly your diabetes 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 diabetes.
Are there other medicines for type 2 diabetes?
There are different groups of medicines that can lower blood sugar levels if you have type 2 diabetes:
- DPP-4 inhibitors or gliptins, such as saxagliptin
- GLP-1 agonists, such as exenatide
- SGLT2 inhibitors, such as empagliflozin
Empagliflozin can be prescribed on its own or in combination with some of these other medicines.
Empagliflozin can be taken on its own when diet and exercise are not enough to control your blood sugar levels, or if you cannot take metformin. It can also be taken with other diabetes medicines, including insulin, when the medicines you are already taking do not control your blood sugars properly.
SGLT2 inhibitors all work in the same way: by increasing the amount of sugar removed from your body when you pee.
These medicines can cause urinary tract infections because of the way they work.
Can I get diabetes medicines for free?
If you have diabetes, you're entitled to free prescriptions for all of your medicines, not just your diabetes ones.
To claim your free prescriptions, you'll need to have a medical exemption certificate (FP92A).
You can get an application form at your GP surgery.
Can I take empagliflozin before surgery?
If you're going to have an operation, tell the doctor that you're taking empagliflozin.
You may need to stop taking your empagliflozin tablets if you need to stop eating before your operation.
This is because there's a risk of diabetic ketoacidosis.
Will it make me lose weight or put on weight?
Empagliflozin can cause weight loss by increasing the amount of sugar that's removed from your body when you pee.
Can I drink alcohol with it? If so, how much?
Yes, you can drink alcohol while taking empagliflozin.
However, alcohol can increase the risk of low blood sugar levels.
Try not to drink on an empty stomach, and try to stick to no more than 2 units of alcohol a day.
A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Is there any food or drink I need to avoid?
It's a good idea to cut down on foods with added sugar. However, ask your doctor for advice before starting a low-calorie, reduced carbohydrate or "ketogenic" diet.
Check the nutrition labels, as many foods and drinks are high in sugar. These include:
- some fizzy drinks
- juice drinks
Be careful when eating food and drink containing karela (also called bitter gourd). This is because it can lower your blood sugar levels, so your diabetes is not controlled as well as it could be.
Karela is used to flavour foods, such as curries like bitter gourd masala. It has a bitter taste, and can also be made into juice and tea.
Will it affect my fertility?
There's no firm evidence that empagliflozin affects either male or female fertility.
Can I drive or ride a bike?
Empagliflozin should not affect your ability to drive or ride a bike.
But if you're taking empagliflozin together with other diabetes medicines, such as sulphonylureas or insulin, it can cause your blood sugar levels to go too low (hypoglycaemia or a "hypo").
Hypos can reduce your concentration. If this happens to you, do not drive, cycle or use machines or tools until you feel better.
Can lifestyle changes help?
There are some lifestyle changes you can make to help control the symptoms of diabetes.
- eating a healthy diet
- losing any excess weight
- not smoking
- cutting down on alcohol – try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol
- exercising – up to 30 minutes a day, 5 times a week is ideal