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 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:
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, 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.
Peeing more than normal
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.
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.
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.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Other side effects
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 using the Yellow Card safety scheme.