Synjardy (empagliflozin/metformin) is a brand-name prescription medication. It’s approved by the Food and Drug Administration (FDA) to treat type 2 diabetes in adults. For this purpose, Synjardy is prescribed in combination with a balanced diet and exercise to help improve blood sugar levels.

Synjardy is meant to be taken as a long-term treatment.

Here are some fast facts about Synjardy:

  • Active ingredients: empagliflozin and metformin
  • Drug classes: sodium glucose cotransporter 2 inhibitor and biguanide
  • Drug forms:
    • Synjardy, which comes as immediate-release (short-acting) oral tablet
    • Synjardy XR, which comes as extended-release (long-acting) oral tablet

Like other drugs, Synjardy can cause negative side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Synjardy, including details about its uses, see this article.

Note: Empagliflozin is also used to help lower the risk of death from certain heart problems.

Synjardy can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Synjardy and Synjardy XR in clinical trials:

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.
† For more information about this side effect, see “Side effect specifics” below.


Mild side effects can occur with Synjardy. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to the prescribing information for Synjardy and Synjardy XR.

Mild side effects that have been reported with Synjardy include:

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Synjardy and want to tell the FDA about it, visit MedWatch.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.
† For more information about this side effect, see “Side effect specifics” below.


Synjardy may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to the prescribing information for Synjardy and Synjardy XR.

If you develop serious side effects while taking Synjardy, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

* Synjardy and Synjardy XR have a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.
† An allergic reaction is possible after using Synjardy. However, it’s not clear whether this side effect occurred in clinical trials.
‡ For more information about this side effect, see “Side effect specifics” below.


Synjardy may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

How are the side effects of Synjardy and Synjardy XR alike and different?

The side effects of Synjardy and Synjardy XR are generally expected to be the same. This is because both Synjardy and Synjardy XR contain the same active ingredients: empagliflozin and metformin.

Synjardy comes as an immediate-release (short-acting) tablet, while Synjardy XR comes as an extended-release (long-acting) tablet. Synjardy XR releases the active drugs slowly into your body over time. For this reason, problems with digestion may be less common with Synjardy XR than with Synjardy.

Examples of these side effects include:

To learn more about what to expect with Synjardy and Synjardy XR, talk with your doctor or pharmacist.

* For more information about this side effect, see “Side effect specifics” below.

Does Synjardy cause severe genital infections?

Yes, in rare cases, Synjardy may cause severe genital infections such as Fournier’s gangrene. This is a rare but life threatening form of flesh-eating disease.

Mild genital infections were common in clinical trials of Synjardy and Synjardy XR. Examples of infections include genital yeast infections in males* and females.* However, Fournier’s gangrene has been reported since Synjardy became available for use.

With Fournier’s gangrene, you may have pain, swelling, and redness or discoloration around your genitals. You may also have a fever or feel unwell.

If you have symptoms of Fournier’s gangrene, tell your doctor right away. Fournier’s gangrene is a rare but life threatening infection that needs to be treated as quickly as possible. This condition usually requires treatment with antibiotics and may require surgery to treat the affected area.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Will Synjardy cause liver problems?

No, it’s not likely. Liver problems weren’t reported in clinical trials of Synjardy and Synjardy XR.

However, having liver problems can increase your risk of lactic acidosis with Synjardy. Synjardy and Synjardy XR have a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about lactic acidosis, see the “Side effect specifics” section below.

If you have liver problems, talk with your doctor before starting treatment with Synjardy. They can advise if the drug is safe for you to take.

Below are details on warnings that may affect whether Synjardy can be taken safely.

Boxed warning: Lactic acidosis

This drug has a boxed warning for lactic acidosis. This is a serious warning from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section below.

Other precautions

Be sure to talk with your doctor about your health history before you take Synjardy. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

History of long-term or recurrent genital yeast infections. Before taking Synjardy, tell your doctor if you have a history of long-term genital yeast infections. Also, tell them if you have genital yeast infections that keep coming back. Synjardy can cause genital yeast infections. And you may have a higher risk of this side effect if you already have long-term or recurrent genital yeast infections. Talk with your doctor about whether Synjardy is right for you.

Liver or kidney problems. Tell your doctor if you have liver or kidney problems before starting treatment with Synjardy. These conditions can increase your risk of lactic acidosis* as a side effect of Synjardy. If you have liver or kidney problems, your doctor can recommend whether Synjardy is right for you.

Metabolic acidosis or diabetic ketoacidosis. Doctors typically will not prescribe Synjardy if you have metabolic acidosis or diabetic ketoacidosis. These conditions raise the level of acid in your blood, which can increase your risk of ketoacidosis as a side effect of Synjardy. If you have metabolic acidosis or ketoacidosis, your doctor will typically treat these conditions before you start taking Synjardy.

Pancreatitis or surgery on the pancreas. Before starting treatment with Synjardy, be sure to tell your doctor if you have pancreatitis (swelling of the pancreas). Also, tell them if you’ve had surgery on your pancreas. These factors can increase your risk of ketoacidosis with Synjardy. (Ketoacidosis is a high level of ketones in your blood, which can raise the level of acid in your blood.) Your doctor can advise if it’s safe for you to take Synjardy.

Allergic reaction. If you’ve had an allergic reaction to Synjardy or any of its ingredients, your doctor will likely not prescribe Synjardy. Ask your doctor what other medications may be better options for you.

Age 65 years or older. If you’re age 65 years or older, you may have an increased risk of lactic acidosis* with Synjardy. You may also be at a higher risk of having low fluid levels in the body. Your doctor will advise if it’s safe for you to take Synjardy.

Planned surgery. Your doctor will advise if it’s safe for you to take Synjardy before a planned surgery. Your doctor may suggest you stop taking the drug temporarily, especially if you’ll be fasting or following a limited diet before the procedure.

Planned imaging tests. Your doctor will advise if it’s safe for you to take Synjardy before a planned imaging test, such as a computerized tomography (CT) scan. Be sure to tell your doctor if you’ll be having a test that uses iodine contrast. (This means iodine will be injected into a vein before the imaging test is performed.) Having this type of test can increase your risk of lactic acidosis* with Synjardy.

* Synjardy and Synjardy XR have a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.

Alcohol with Synjardy

It’s best to avoid drinking large amounts of alcohol while taking Synjardy. Consuming large amounts of alcohol can increase your risk of lactic acidosis,* which is a possible serious side effect of the drug.

If you drink alcohol, talk with your doctor about how much is safe to consume while taking Synjardy.

* Synjardy and Synjardy XR have a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.

Pregnancy and breastfeeding while taking Synjardy

It may not be safe to take Synjardy during the second and third trimesters of pregnancy. It’s also recommended that you avoid taking Synjardy while breastfeeding.

If you’re pregnant, breastfeeding, or planning either, talk with your doctor. They can advise on the risks of taking Synjardy during these times.

Learn more about some of the side effects that Synjardy may cause.

Nausea

Synjardy may cause nausea. This was a common side effect in clinical trials of Synjardy and Synjardy XR.

What you can do

It’s recommended that you take Synjardy with a meal. This can help ease any nausea you may have while taking Synjardy.

Keep in mind that Synjardy comes in two forms:

  • Synjardy, which comes as an immediate-release (short-acting) tablet
  • Synjardy XR, which comes as an extended-release (long-acting) tablet

Synjardy XR is released slowly into your body over time. For this reason, problems with digestion (such as nausea) may be less common with Synjardy XR than with Synjardy. If you take Synjardy and you’re interested in taking Synjardy XR instead, talk with your doctor.

If you have bothersome nausea while taking Synjardy, talk with your doctor. They can suggest other ways to ease your symptoms.

Low fluid levels in the body

Synjardy may cause low fluid levels in the body.

In rare cases, low fluid levels led to certain side effects in clinical trials of Synjardy and Synjardy XR. Examples of these side effects include dehydration and low blood pressure. Low blood pressure can cause symptoms such as dizziness, lightheadedness, and fainting.

Kidney problems resulting from low fluid levels have also been reported since Synjardy became available for use. Symptoms of this condition include dark urine, urinating a smaller amount than usual, and swelling in your legs.

Keep in mind that Synjardy can also cause frequent urination as a side effect, which may lower the level of fluid in your body even more.

You may have a higher risk of low fluid levels with Synjardy if you’re age 65 years or older, or if you take loop diuretics. Loop diuretics are prescribed to treat conditions such as heart failure and high blood pressure. Examples include furosemide (Lasix) and bumetanide (Bumex).

What you can do

If you have symptoms of the conditions above while taking Synjardy, tell your doctor right away. They can advise if it’s safe for you to continue taking Synjardy.

To lower your risk of low fluid levels with Synjardy, be sure to drink plenty of fluids while taking the drug. Also, be sure to tell your doctor about all medications you take. They can tell you if any of your medications may increase your risk of low fluid levels with Synjardy.

Lactic acidosis

Synjardy and Synjardy XR have a boxed warning for lactic acidosis. A boxed warning is a serious warning from the FDA. It alerts patients and doctors about possible dangerous effects of a drug.

Lactic acidosis happens when there’s too much lactic acid in your blood. In rare cases, lactic acidosis can be fatal. This side effect wasn’t reported in clinical trials of Synjardy and Synjardy XR. However, lactic acidosis is a known risk of metformin (one of the active ingredients in Synjardy).

Symptoms of lactic acidosis may include pain in your abdomen, sleepiness, trouble breathing, and muscle pain.

Below are factors that can raise your risk of lactic acidosis with Synjardy:

What you can do

Before taking Synjardy, tell your doctor about all your health conditions, medications you’re taking, and any upcoming procedures. They can advise if you have any factors that raise your risk of lactic acidosis.

If you have symptoms of lactic acidosis, stop taking Synjardy and tell your doctor right away. If your symptoms are severe or seem life threatening, immediately call 911 or your local emergency number.

Allergic reaction

As with most drugs, Synjardy can cause an allergic reaction in some people. However, it’s not clear whether this side effect occurred in clinical trials of Synjardy and Synjardy XR.

Symptoms can be mild or serious and can include:

  • skin rash
  • itching
  • flushing
  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Synjardy. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Taking Synjardy may lead to mild or serious side effects. Most of the drug’s side effects are mild. However, be sure to tell your doctor if you have symptoms of serious side effects while taking the drug.

If you’d like to learn more about Synjardy, talk with your doctor or pharmacist. They can help answer any questions you have about side effects of taking the drug.

In addition to talking with your doctor, you can do some research on your own. These articles might help:

  • More information about Synjardy. For details about other aspects of Synjardy, refer to this article.
  • Dosage details. If you’d like to learn the specifics of Synjardy’s dosage, see this article.
  • Drug comparison. To learn how Synjardy compares with other drugs, read the comparisons with Jardiance and Invokamet.
  • A look at type 2 diabetes. For details about type 2 diabetes, see our diabetes hub and list of diabetes articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.