Home Drug Guide Empagliflozin and Metformin Hydrochloride

Drug Guide

Generic Name

Empagliflozin and Metformin Hydrochloride

Brand Names Syncmet, Synjardy

Classification

Therapeutic: Antidiabetic agent, oral combination

Pharmacological: SGLT2 inhibitor (Empagliflozin), Biguanide (Metformin)

FDA Approved Indications

Type 2 diabetes mellitus

Mechanism of Action

Empagliflozin inhibits SGLT2 in the kidneys, reducing glucose reabsorption and increasing urinary glucose excretion. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity.

Dosage and Administration

Adult: Based on combination therapy, typically 10 mg empagliflozin once daily with meals, and titrated metformin dose up to a maximum of 2000 mg/day in divided doses.

Pediatric: Not recommended for pediatric use.

Geriatric: Adjust doses based on renal function, monitor closely for adverse effects.

Renal Impairment: Use with caution; contraindicated in severe renal impairment (eGFR <30 mL/min/1.73 m²).

Hepatic Impairment: Use with caution; contraindicated in hepatic disease associated with hypoxia.

Pharmacokinetics

Absorption: Empagliflozin is well absorbed; Metformin has variable absorption, with a bioavailability of 50-60%.

Distribution: Empagliflozin is extensively distributed; Metformin distributes into red blood cells.

Metabolism: Empagliflozin is minimally metabolized; Metformin is not metabolized.

Excretion: Both drugs are renally excreted; Empagliflozin mainly unchanged; Metformin primarily unchanged via urine.

Half Life: Empagliflozin approx. 13 hours; Metformin approx. 4-8 hours.

Contraindications

Hypersensitivity to components
Severe renal impairment (eGFR <30 mL/min/1.73 m²)
Diabetic ketoacidosis

Precautions

Use with caution in hypovolemia, hypotension, urinary tract infections, renal impairment.

Adverse Reactions - Common

Genital fungal infections in females and males (Common)
Urinary tract infections (Common)
Nausea, vomiting (Common)

Adverse Reactions - Serious

Lactic acidosis (Rare)
Ketoacidosis (Rare)
Severe renal impairment or failure (Rare)

Drug-Drug Interactions

Diuretics, antihypertensive agents, other antidiabetic agents, drugs affecting renal function

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose, renal function (serum creatinine, eGFR), signs of dehydration or hypotension.

Diagnoses:

Risk for hypoglycemia
Risk for dehydration
Risk for infection

Implementation: Administer with meals to reduce gastrointestinal side effects; advise adequate hydration.

Evaluation: Assess blood glucose control and renal function regularly.

Patient/Family Teaching

Take with meals to reduce gastrointestinal side effects.
Report signs of urinary tract infections, genital infections, or symptoms of ketoacidosis.
Maintain adequate hydration.
Follow prescribed laboratory monitoring.

Special Considerations

Black Box Warnings:

Risk of lactic acidosis with metformin, especially in renal impairment.

Genetic Factors: None specific.

Lab Test Interference: May affect renal function tests.

Overdose Management

Signs/Symptoms: Hypoglycemia, lactic acidosis (metformin overdose), dehydration.

Treatment: Discontinue medication, provide supportive care, correct hypoglycemia with glucose, treat lactic acidosis with supportive measures and possibly hemodialysis.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for at least 24 months when stored properly.