Select a medication above to begin.
Synjardy XR
empagliflozin/ metformin
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle w/ nonspecific sx incl. malaise, myalgias, resp. distress, somnolence, abdominal pain; lab findings incl. lactate >5 mmol/L, anion gap acidosis (w/o evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may incl. renal impairment, concomitant meds, pts 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immed. if lactic acidosis suspected, hospitalize pt and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: ER TAB: 5 mg/1000 mg, 10 mg/1000 mg, 12.5 mg/1000 mg, 25 mg/1000 mg
diabetes mellitus, type 2
- [conversion from metformin]
- Dose: 1-2 tabs PO qam; Start: empagliflozin 10 mg PO qam plus current total daily metformin dose PO qam; Max: 25 mg/2000 mg/day; Info: give w/ meal; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see empagliflozin for cardiovascular event risk reduction use, heart failure risk reduction use, or kidney dz progression and cardiovascular-associated risk reduction use
- [conversion from empagliflozin]
- Dose: 1-2 tabs PO qam; Start: current total daily empagliflozin dose PO qam plus metformin 1000 mg PO qam; Max: 25 mg/2000 mg/day; Info: give w/ meal; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see empagliflozin for cardiovascular event risk reduction use, heart failure risk reduction use, or kidney dz progression and cardiovascular-associated risk reduction use
- [conversion from empagliflozin plus metformin]
- Dose: 1-2 tabs PO qam; Start: equivalent total daily dose of each component in current regimen PO qam; Max: 25 mg/2000 mg/day; Info: give w/ meal; do not cut/crush/chew tab; hold tx at least 3 days before surgery/procedure if prolonged fasting; D/C for iodinated contrast study if eGFR <60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn; see empagliflozin for cardiovascular event risk reduction use, heart failure risk reduction use, or kidney dz progression and cardiovascular-associated risk reduction use
renal dosing
- [see below]
- eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit if eGFR 30-44 during tx
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.