Synjardy is a brand-name prescription drug that’s FDA-approved for use in adults with type 2 diabetes. It’s used to help improve blood sugar levels in combination with healthy diet and regular exercise.

Synjardy comes as tablets that are taken by mouth with meals. It’s a combination medication that contains two active drugs: metformin (Glucophage) and empagliflozin (Jardiance).

Metformin belongs to a class of drugs called biguanides. (A medication class is a group of drugs that work in a similar way). And empagliflozin belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors. These drugs work in slightly different ways to lower blood sugar levels.

Synjardy vs. Synjardy XR

Synjardy comes as tablets that are taken by mouth with meals. It’s available in the following two forms:

  • Synjardy. This form of the drug is taken twice daily. It’s an immediate-release form of the medication.
  • Synjardy XR. This form of the drug is taken once daily. It’s an extended-release form of the medication. Synjardy XR is specially made to be slowly released into your body throughout the day.

Taking Synjardy XR allows you the convenience of taking your full daily dose once a day, instead of taking the regular form of the drug twice each day. Your doctor will recommend which form of Synjardy best fits your needs.

Effectiveness

A clinical study compared the two active drugs in Synjardy (metformin and empagliflozin) with metformin plus a placebo. (A placebo is a treatment that doesn’t contain any active drug.)

After 24 weeks of treatment, people taking empagliflozin plus metformin had their:

  • hemoglobin A1c (HbA1c) level* lowered by 0.7% to 0.8%. In comparison, the level was lowered by 0.1% in people taking metformin plus a placebo.
  • fasting blood sugar level** lowered by 20 mg/dL to 22 mg/dL. In comparison, the level was increased by 6 mg/dL in people taking metformin plus a placebo.
  • body weight decreased by 2.5% to 2.9%. In comparison, body weight was decreased by 0.5% in people taking metformin plus a placebo.

* HbA1c is a measurement that shows your average blood sugar levels over the past 2 to 3 months. The American Diabetes Association (ADA) recommends a HbA1c goal of less than 7.0% for most adults.

**Fasting blood sugar is measured after you’ve fasted for a certain period of time. The ADA recommends a fasting blood sugar level of 80 mg/dL to 130 mg/dL for most adults.

For more information on Synjardy’s effectiveness, see the section below called “Synjardy uses”.

Synjardy is available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Synjardy contains two active drug ingredients: empagliflozin and metformin.

Synjardy can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Synjardy. These lists do not include all possible side effects.

For more information on the possible side effects of Synjardy, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they’ve approved. If you would like to report to the FDA a side effect you’ve had with Synjardy, you can do so through MedWatch.

Mild side effects

The mild side effects of Synjardy that are more common* can include:

The mild side effects of Synjardy that are less common** can include:

* occurred in more than 5% of people in clinical studies

** occurred in 5% or less of people in clinical studies

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Synjardy aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Hypoglycemia (low blood sugar level). Symptoms can include:
    • confusion
    • dizziness
    • feeling irritable or anxious
    • loss of consciousness
    • shakiness
    • sweating
  • Hypotension (low blood pressure). Symptoms can include:
    • clammy or cold skin
    • depression
    • falling or feeling dizzy when standing up
    • feeling lightheaded
  • Kidney damage. Symptoms can include:
    • confusion
    • decreased urination
    • fatigue (lack of energy)
    • swelling in your ankles and legs
  • Increased low-density lipoprotein (LDL) cholesterol level.

Other serious side effects, which are explained in more detail below in “Side effect details,” include:

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Synjardy. But it’s not known for sure how many people have had an allergic reaction while using Synjardy.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing or speaking

Call your doctor right away if you have a severe allergic reaction to Synjardy. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Diarrhea

Diarrhea is a common side effect of metformin, which is one of the active drugs in Synjardy. It’s estimated that 5% of people who use metformin stop taking the drug because of diarrhea.

Because Synjardy contains metformin, it’s possible to have diarrhea while you’re taking Synjardy. Keep in mind that most people who have diarrhea as a side effect will only have it during the first few weeks of treatment. But the side effect can occur at any time, even if you’ve been taking Synjardy for a long time.

Synjardy is meant to be taken with meals. And doing so may even help lower your risk of diarrhea from the drug.

If you have diarrhea while you’re taking Synjardy, talk with your doctor. They may switch you to the extended-release form of the drug (called Synjardy XR). Doing this can help reduce your risk of diarrhea.

Gangrene

Gangrene has occurred in people taking empagliflozin, one of the active drugs in Synjardy. This condition is a type of infection that causes areas of your body’s tissue to die.

In addition, gangrene has happened in people taking medications that belong to the same drug class as empagliflozin does. (A drug class describes a group of medications that work in the same way.) So, this side effect isn’t specific to just Synjardy.

Specifically, a certain type of gangrene called Fournier’s gangrene has been reported in people taking empagliflozin.

Fournier’s gangrene causes tissue that’s in and around your genital area to become infected and to die. Fournier’s gangrene is rare, but life threatening. And it can occur in both males and females.

Symptoms of Fournier’s gangrene include:

  • malaise (generally not feeling well)
  • chills or fever
  • pain, redness, swelling, or tenderness near your genitals or rectum

If you have any of these symptoms while you’re taking Synjardy, stop taking the drug and call your doctor right away.

Fournier’s gangrene is serious, and it requires immediate medical treatment. For this condition, treatment may include hospitalization and medication. In some cases, treatment may possibly include surgery, such as amputation.

Ketoacidosis

It’s possible to have ketoacidosis while you’re taking Synjardy. With ketoacidosis, you have an abnormally high level of ketones (a type of protein) in your body.

Normally, ketones are made when your body breaks down fat that you’ve consumed in your diet. But taking empagliflozin (one of the active drugs in Synjardy) can cause your body to make even more ketones. This means that taking the drug may lead to a buildup of ketones. And when ketones build up, they can cause your blood to become too acidic.

Symptoms of ketoacidosis include:

  • excessive thirst
  • frequent urination
  • fruity-scented breath
  • nausea or vomiting
  • rapid, shallow breathing or feeling short of breath
  • stomach (belly) pain
  • tiredness

Some people have a higher risk for ketoacidosis than other people do. This includes people with a history of pancreatitis (inflammation in your pancreas). It also includes people who drink excessive amounts of alcohol and those with a fever or reduced food intake due to illness.

Ketoacidosis is a very serious, life threatening condition. If you have ketoacidosis, you’ll need to be hospitalized and receive medical treatment right away.

If you have symptoms of ketoacidosis, stop taking Synjardy and call your doctor right away. If your symptoms feel severe, call 911 or have someone take you to the nearest emergency room.

Lactic acidosis

Lactic acidosis has been reported in people taking metformin, which is one of the active drugs in Synjardy.

Because this side effect is also possible with Synjardy, the Food and Drug Administration (FDA) has placed a boxed warning on Synjardy for lactic acidosis. A boxed warning is the strongest FDA warning required. It alerts doctors and patients about drug effects that may be dangerous.

Lactic acidosis is very serious condition. With lactic acidosis, you have high levels of lactic acid in your blood. This causes your blood to be more acidic than usual. Lactic acidosis is a life-threatening emergency, and it requires immediate medical attention.

It’s important to note that metformin has been related to some fatal cases of lactic acidosis. These cases were seen in people using the drug after it became available on the market. But no cases of fatal lactic acidosis were seen during clinical studies of Synjardy.

Risk factors for lactic acidosis that’s related to metformin

Lactic acidosis that’s related to metformin is extremely rare. But certain people may have a higher risk of developing the condition. This includes people:

  • with liver or kidney problems
  • ages 65 years and older
  • who are about to have surgery
  • who drink excessive amounts of alcohol

If you’re concerned about developing lactic acidosis while taking Synjardy, talk with your doctor. They can help you determine your risks for having this side effect. In some cases, your doctor may recommend that you use a drug other than Synjardy to treat your diabetes.

Symptoms of lactic acidosis

Symptoms of lactic acidosis include:

  • trouble breathing
  • dizziness or lightheadedness
  • nausea or vomiting
  • slow heart rate or irregular heartbeat
  • stomach (belly) pain
  • unusual muscle pain
  • sleepiness
  • weakness
  • feeling cold in your hands or feet

What to do for lactic acidosis

If you have symptoms of lactic acidosis, stop taking Synjardy and call your doctor right away. But if your symptoms feel life threatening, call 911 or have someone take you to the nearest emergency room.

Urinary tract infection

Urinary tract infection (UTI) is a common side effect of empagliflozin (one of the active drugs in Synjardy).

In fact, during one clinical study, 6.9% to 9.4% of people taking empagliflozin had a UTI. In comparison, UTI occurred in 6.7% of people who took a placebo (no active drug). And in another study, 7.6% to 9.3% of people taking empagliflozin had a UTI. And 7.6% of people taking a placebo (no active drug) had a UTI.

In clinical studies, UTI’s occurred in both men and women taking empagliflozin. However, women were affected more often than men were.

For example, 17.0% to 18.4% of women taking empagliflozin had a UTI. In comparison, 3.6% to 4.1% of men using the drug had a UTI. But it’s important to note that of people taking a placebo, 16.6% of women and 3.2% of men had a UTI.

Symptoms of UTI include:

If left untreated, UTIs may sometimes develop into serious infections. If you have symptoms of a UTI, call your doctor. They can recommend appropriate treatment, if needed.

Typically, UTIs can be treated with an antibiotic. And you shouldn’t need to stop taking Synjardy while your UTI is being treated.

Weight loss

Synjardy isn’t approved for use as a weight loss aid, and it shouldn’t be used for this purpose. However, if you have diabetes and your blood sugar level needs to be better managed, using Synjardy may lead to some amount of weight loss.

In clinical studies, people taking Synjardy lost 2.5% to 2.9% of their body weight over 24 weeks of treatment. For people in the studies, their average starting weight was about 180 pounds (around 82 kilograms). So this means that on average, people lost about 5.5 pounds (2.5 kilograms) of body weight during the study.

In comparison, people who took a placebo (no active treatment) lost an average of 0.5% of their body weight over 24 weeks.

If you have questions about weight loss during Synjardy treatment, talk with your doctor. They can help you develop a plan to manage both your diabetes and a healthy body weight.

The Synjardy dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Synjardy to treat
  • your age
  • the form of Synjardy you take
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Synjardy, which contains both metformin and empagliflozin, comes as tablets that are taken by mouth. This medication should be taken with meals.

Synjardy is available in the following two forms:

  • Synjardy. This form comes as tablets that are taken by mouth twice daily. It’s an immediate-release form of the drug. Synjardy is available in four strengths:
    • 5 mg empagliflozin / 500 mg metformin
    • 5 mg empagliflozin / 1,000 mg metformin
    • 12.5 mg empagliflozin / 500 mg metformin
    • 12.5 mg empagliflozin / 1,000 mg metformin
  • Synjardy XR. This form is taken by mouth once daily. It’s an extended-release form of the drug. Synjardy XR is specially made to be slowly released into your body throughout the day. Synjardy XR is also available in four strengths:
    • 5 mg empagliflozin / 1,000 mg metformin
    • 10 mg empagliflozin / 1,000 mg metformin
    • 12.5 mg empagliflozin / 1,000 mg metformin
    • 25 mg empagliflozin / 1,000 mg metformin

Taking Synjardy XR allows you the convenience of taking your full daily dose once a day, instead of taking the regular form of the drug twice each day.

Dosage for type 2 diabetes

For type 2 diabetes, the typical starting dosage for either Synjardy or Synjardy XR varies. For example, your dosage of either drug depends on whether you’re already taking metformin, empagliflozin, or both medications.

Based on your current treatment regimen, your doctor will recommend a dosage of Synjardy that’s right for you.

In any case, if your doctor prescribes regular-form Synjardy tablets, you’ll take your doses twice each day with meals. But if your doctor prescribes Synjardy XR tablets, you’ll only need to take a dose once each day with your morning meal.

What if I miss a dose?

If you miss a dose of Synjardy, take it as soon as you remember. But if it’s almost time for your next dose, just skip the missed dose and take your next scheduled dose. Don’t “double up” by taking two doses of Synjardy at the same time. Doing this can increase your risk of side effects from the drug.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Synjardy is meant to be used as a long-term treatment. If you and your doctor determine that Synjardy is safe and effective for you, you’ll likely take it long term.

Other drugs are available that can treat type 2 diabetes. Some may be a better fit for you than others. If you’re interested in finding an alternative to Synjardy, talk with your doctor. They can tell you about other medications that may work well for you.

Synjardy is a combination medication that contains two active drugs: metformin (Glucophage) and empagliflozin (Jardiance). Metformin belongs to a class of drugs called biguanides. (A medication class is a group of drugs that work in a similar way). And empagliflozin belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Examples of other drugs that may be used to treat type 2 diabetes are listed below. Some of these drugs belong to the same class of drugs as Synjardy’s active drugs do. But some alternatives belong to a different drug class.

The following drug classes each work in different ways to help lower and manage your blood sugar level:

  • biguanides, such as:
  • combination drugs that contain a biguanide and an SGLT2 inhibitor, such as:
    • canagliflozin/metformin (Invokamet, Invokamet XR)
    • dapagliflozin/metformin (Xigduo, Xigduo XR)
    • ertugliflozin/metformin (Segluromet)
  • dipeptidyl peptidase-4 (DPP-4) inhibitors, such as:
    • linagliptin (Tradjenta)
    • saxagliptin (Onglyza)
    • sitagliptin (Januvia)
  • sulfonylureas, such as:
  • thiazolidinediones, such as:
    • pioglitazone (Actos)
    • rosiglitazone (Avandia)

You may wonder how Synjardy compares with other medications that are prescribed for similar uses. Here we look at how Synjardy and Invokamet are alike and different.

Ingredients

Synjardy contains two active drugs: metformin and empagliflozin. Invokamet also contains two active drugs: metformin and canagliflozin.

Both empagliflozin and canagliflozin belong to a class of drugs called sodium-glucose cotransporter (SGLT2) inhibitors. (A drug class is a group of medications that work in similar ways). These drugs work in the same way to manage blood sugar levels.

Uses

Synjardy and Invokamet are both approved to lower blood sugar levels in adults with type 2 diabetes. For this use, the drugs are meant to be used in combination with a healthy diet and regular exercise.

Drug forms and administration

Synjardy and Invokamet both come as tablets that are taken by mouth with food.

Synjardy comes in the following forms:

  • Synjardy. This form is taken twice daily with meals.
  • Synjardy XR. This form is taken once daily with your morning meal.

And Invokamet comes in the following forms:

  • Invokamet. This form is taken twice daily with meals.
  • Invokamet XR. This form is taken once daily with your morning meal.

The “XR” forms of each medication are extended-release forms. Unlike the immediate-release forms of the drugs, they’re made to slowly release the medication into your body throughout the day. Taking an XR form allows you the convenience of taking your full daily dose once a day, instead of taking the regular form of the drug twice each day.

Side effects and risks

Synjardy and Invokamet both contain metformin. And they each contain an SGLT2 inhibitor. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Synjardy, with Invokamet, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Synjardy, with Invokamet, or with both drugs (when taken individually).

Effectiveness

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Synjardy and Invokamet to be effective in treating type 2 diabetes.

Costs

Synjardy and Invokamet are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Synjardy and Invokamet generally cost about the same. The actual price you’ll pay for either drug will depend on your insurance plan, your location, and the pharmacy you use.

You may wonder how Synjardy compares with other medications that are prescribed for similar uses. Here we look at how Synjardy and Jardiance are alike and different.

Ingredients

Synjardy and Jardiance both contain the drug empagliflozin. However, in addition to empagliflozin, Synjardy also contains metformin.

Metformin belongs to a class of drugs called biguanides. (A drug class is a group of medications that work in similar ways). Empagliflozin belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors. Metformin and empagliflozin work in slightly different ways, but they both lower blood sugar levels.

Uses

Synjardy and Jardiance are both approved to lower blood sugar levels in adults with type 2 diabetes. These drugs are meant to be used in combination with a healthy diet and regular exercise.

In addition, Jardiance is also approved to reduce the risk of death that’s caused by heart disease. For this use, it can be given to people with both type 2 diabetes and heart disease.

Drug forms and administration

Synjardy and Jardiance both come as tablets that are taken by mouth.

Synjardy is available in the following two forms, which should each be taken with food:

  • Synjardy. This immediate-release form of Synjardy is taken twice daily with meals.
  • Synjardy XR. This extended-release form of Synjardy is taken once daily with your morning meal.

Jardiance, on the other hand, only comes in one form. And it’s taken once a day in the morning, with or without food.

Side effects and risks

Synjardy and Jardiance both contain empagliflozin. Therefore, these medications can cause very similar side effects. Synjardy also contains the drug metformin, which is why Synjardy has a few additional side effects compared with Jardiance. Below are examples of the side effects of these drugs.

Mild side effects

These lists contain examples of mild side effects that can occur with Synjardy, with Jardiance, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Synjardy, with Jardiance, or with both drugs (when taken individually).

Effectiveness

The use of Synjardy and Jardiance in treating type 2 diabetes has been directly compared in a clinical study.

In this study, researchers looked to see if metformin plus empagliflozin (the active drugs in Synjardy) were more effective in managing blood sugar than using either drug alone. (Keep in mind that empagliflozin alone is the active drug in Jardiance.)

People in the study who took empagliflozin plus metformin received one of the following daily regimens:

  • empagliflozin 10 mg and metformin 1,000 mg
  • empagliflozin 10 mg and metformin 2,000 mg
  • empagliflozin 25 mg and metformin 1,000 mg
  • empagliflozin 25 mg and metformin 2,000 mg

People who took empagliflozin alone received either 10 mg or 25 mg daily. And people who took metformin alone received either 1,000 mg or 2,000 mg daily.

At the end of the study, people who took empagliflozin plus metformin had a lower hemoglobin A1c (HbA1c) level* than did people taking either drug alone.

For example, people taking both empagliflozin and metformin had their HbA1c lowered by 0.6% to 0.7% more than did people taking empagliflozin alone. And people taking both empagliflozin and metformin had their HbA1c lowered 0.3% to 0.8% more than did people taking metformin alone.

* HbA1c is a measurement that shows your average blood sugar levels over the past 2 to 3 months. The American Diabetes Association recommends a HbA1c goal of less than 7.0% for most adults.

Costs

Synjardy and Jardiance are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Synjardy and Jardiance generally cost about the same. The actual price you’ll pay for either drug will depend on your insurance plan, your location, and the pharmacy you use.

Synjardy is approved to lower blood sugar levels in adults with type 2 diabetes. It’s meant to be used in combination with a healthy diet and regular exercise.

How your body manages blood sugar levels

When you eat food, your body releases a hormone called insulin. This hormone helps your body move glucose (sugar) out of your bloodstream and into your cells. Once inside your cells, your body uses the sugar to create energy.

People with type 2 diabetes usually have some resistance to insulin. With resistance, their bodies don’t respond to insulin like usual. Over time, if their diabetes isn’t properly managed, their bodies may stop making insulin altogether.

Without insulin, your cells can’t bring in glucose from your bloodstream. This affects how well your body’s cells are able to function. And it can also cause your blood sugar level to become too high (hyperglycemia).

Hyperglycemia can result in many health problems. In fact, this condition can affect several parts of your body, including your:

  • eyes
  • heart
  • kidneys
  • nerves

What Synjardy does

Synjardy contains two active drugs: metformin and empagliflozin.

Metformin belongs to a class of drugs called biguanides. (A drug class is a group of medications that work in similar ways). In fact, metformin is the only biguanide available. It works through many ways to lower your blood sugar level. Specifically, it works by:

  • decreasing the amount of glucose that your body absorbs from food
  • increasing your body’s response to insulin
  • reducing the amount of glucose that’s made by your liver

Empagliflozin, on the other hand, belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors. It works by making your kidneys eliminate excess glucose from your blood. Your kidneys do this by forcing the sugar out of your body through your urine.

How long does it take to work?

Synjardy starts working in your body shortly after you take it. However, it may take several days or even 1 to 2 weeks before Synjardy has its full effect on lowering your blood sugar level. And you likely won’t notice changes in your hemoglobin A1c (HbA1c) level* for a few months after starting Synjardy.

* HbA1c is a measurement that shows your average blood sugar levels over the past 2 to 3 months. The American Diabetes Association recommends a HbA1c goal of less than 7.0% for most adults.

The Food and Drug Administration (FDA) approves prescription drugs such as Synjardy to treat certain conditions.

Synjardy is FDA-approved to lower blood sugar levels in adults with type 2 diabetes. It’s meant to be used in combination with a healthy diet and regular exercise.

Your blood sugar level is typically managed by a hormone called insulin. But people with type 2 diabetes usually have some resistance to insulin. (With resistance, their bodies don’t respond to insulin like usual.) Over time, if their diabetes isn’t properly managed, their bodies may stop making insulin altogether.

Without insulin, your cells can’t process glucose from your bloodstream. This affects how well your body’s cells are able to function. And it can also cause your blood sugar level to become too high (hyperglycemia).

Effectiveness for type 2 diabetes

In clinical studies, Synjardy has been effective in lowering blood sugar levels in people with type 2 diabetes. Results of some of these studies are described below.

Effectiveness when compared to metformin

One clinical study compared the two active drugs in Synjardy (metformin and empagliflozin) with metformin plus a placebo. (A placebo is a treatment that doesn’t contain any active drug.)

After 24 weeks of treatment, people taking empagliflozin plus metformin had their:

  • hemoglobin A1c (HbA1c) level* lowered by 0.7% to 0.8%. In comparison, the level was lowered by 0.1% in people taking metformin plus a placebo.
  • fasting blood sugar level** lowered by 20 mg/dL to 22 mg/dL. In comparison, the level was increased by 6 mg/dL in people taking metformin plus a placebo.
  • body weight decreased by 2.5% to 2.9%. In comparison, body weight was decreased by 0.5% in people taking metformin plus a placebo.

* HbA1c is a measurement that shows your average blood sugar levels over the past 2 to 3 months. The American Diabetes Association (ADA) recommends a HbA1c goal of less than 7.0% for most adults.

**Fasting blood sugar is measured after you’ve fasted for a certain period of time. The ADA recommends a fasting blood sugar level of 80 mg/dL to 130 mg/dL for most adults.

Effectiveness when compared to either metformin or empagliflozin

In another study, researchers looked to see if metformin plus empagliflozin (the active drugs in Synjardy) was more effective in managing blood sugar than using either drug alone. People in the study who took empagliflozin plus metformin received one of the following daily regimens:

  • empagliflozin 10 mg and metformin 1,000 mg
  • empagliflozin 10 mg and metformin 2,000 mg
  • empagliflozin 25 mg and metformin 1,000 mg
  • empagliflozin 25 mg and metformin 2,000 mg

People who took empagliflozin alone received either 10 mg or 25 mg daily. And people who took metformin alone received either 1,000 mg or 2,000 mg daily.

At the end of the study, people who took empagliflozin plus metformin had a lower hemoglobin A1c (HbA1c) level* than did people taking either drug alone.

For example, people taking both empagliflozin and metformin had their HbA1c lowered by 0.6% to 0.7% more than did people taking empagliflozin alone. And people taking both empagliflozin and metformin had their HbA1c lowered 0.3% to 0.8% more than did people taking metformin alone.

* HbA1c is a measurement that shows your average blood sugar levels over the past 2 to 3 months. The American Diabetes Association (ADA) recommends a HbA1c goal of less than 7.0% for most adults.

Synjardy and children

People younger than 18 years of age weren’t included in clinical studies of Synjardy. Because of this, it’s not known for sure if Synjardy is safe or effective for people less than 18 years old.

Synjardy is approved for use in adults. It’s not approved for people younger than 18 years of age.

Synjardy may be used alone or in combination with other drugs to manage blood sugar levels and treat type 2 diabetes.

When treating diabetes, sometimes using just one drug alone isn’t enough to improve your blood sugar level. In this case, your doctor may recommend that you take more than one medication to treat your diabetes.

Depending on how well your blood sugar level is managed, your doctor will recommend whether you’ll need to use other drugs with Synjardy.

You should avoid drinking large amounts of alcohol while you’re taking Synjardy.

This is because alcohol can affect your blood sugar level, which makes it harder for your body to properly manage the level. Alcohol can also increase your risk of:

Drinking alcohol while you’re taking Synjardy can also increase your risk of lactic acidosis.

This condition is a possible side effect of metformin, one of the active drugs in Synjardy. Lactic acidosis is a buildup of lactic acid in your blood. This condition is a medical emergency that requires immediate treatment in a hospital.

For more information about lactic acidosis, see the section above called “Synjardy side effects”.

If you have questions about the safety of drinking alcohol while using Synjardy, talk with your doctor.

Synjardy can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Synjardy and other medications

Below are lists of medications that can interact with Synjardy. These lists do not contain all the drugs that may interact with Synjardy.

Before taking Synjardy, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Synjardy and other diabetes medications

It’s common for people with diabetes to take more than one medication to manage their blood sugar level. However, when used with Synjardy, certain diabetes medications can increase your risk of hypoglycemia (low blood sugar).

Specifically, insulins and medications that increase your insulin level can interact this way with Synjardy.

Examples of insulin medications that may cause hypoglycemia if taken with Synjardy include:

Examples of diabetes medications that increase insulin levels and may cause hypoglycemia if taken with Synjardy include:

If you’re taking more than one diabetes medication, talk with your doctor about your risk of hypoglycemia. Your doctor can recommend ways to help you avoid having low blood sugar levels.

In some cases, your doctor may adjust your dosage of either Synjardy or your other diabetes medications to help reduce your risk of this condition.

Synjardy and certain blood pressure drugs

Taking Synjardy with certain blood pressure drugs called diuretics (water pills) can increase your risk of low blood pressure. Both Synjardy and diuretics increase the amount of urine that your body makes. The drugs may also make you urinate more often than usual.

Because urinating pushes fluid out of your body, increased urination can lead to both dehydration (low fluid level) and low blood pressure.

Commonly used diuretics include:

If you’re taking any blood pressure medications, talk with your doctor. They’ll help determine whether Synjardy is safe for you to take with your other medications.

Synjardy and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Synjardy. However, you should still check with your doctor or pharmacist before using any of these products while taking Synjardy.

As with all medications, the cost of Synjardy can vary.

The actual price you’ll pay will depend on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before they approve coverage for Synjardy. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Synjardy.

If you’re not sure if you’ll need to get prior authorization for Synjardy, contact your insurance plan.

Financial and insurance assistance

If you need financial support to pay for Synjardy, or if you need help understanding your insurance coverage, help is available.

Boehringer Ingelheim Pharmaceuticals Inc., the manufacturer of Synjardy, offers a savings card that may help to lower the cost of your prescription. For more information and to find out if you’re eligible for support, visit the program website.

You should take Synjardy according to your doctor or healthcare provider’s instructions.

When to take

Synjardy comes in two forms, which should each be taken by mouth with a meal. When you’ll need to take the medication depends on which of the following forms you’re using:

  • Synjardy. This immediate-release form of Synjardy is taken twice daily with meals.
  • Synjardy XR. This extended-release form of Synjardy is taken once daily with your morning meal.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Synjardy with food

You should take Synjardy with food. Doing this can help you avoid certain side effects, such as upset stomach and diarrhea.

Can Synjardy be crushed, split, or chewed?

It depends on what form of Synjardy you’re taking.

Synjardy XR tablets need to be taken whole. These tablets shouldn’t be crushed, split, or chewed.

Doing any of these things can destroy the special coating on the medication that makes it “extended-release” in your body. Without this coating intact, all of the medication is released at once, which can increase your risk of side effects.

However, the drug manufacturer hasn’t stated whether regular-form Synjardy tablets can be crushed, split, or chewed. If you’d like to know whether you can break these tablets, talk with your doctor or pharmacist.

It’s recommended that you don’t use Synjardy during the second and third trimesters of pregnancy.

This is because in animal studies, kidney damage was seen in fetuses of pregnant females who took empagliflozin during those trimesters. (Empagliflozin is one of the active drugs in Synjardy.)

Keep in mind that animal studies don’t always predict what might happen in humans. However, these studies did show possible risk if the drug is used during the second and third trimesters of pregnancy.

If you’re pregnant or may become pregnant, talk with your doctor about whether it’s safe for you to use Synjardy. They can help you decide if this drug is a good treatment option for you.

It’s recommended that Synjardy be avoided during the second and third trimesters of pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Synjardy.

Using Synjardy while breastfeeding is not recommended.

In animal studies, empagliflozin was passed into the breast milk of lactating females who were given the drug. (Empagliflozin is one of the active drugs in Synjardy.)

It’s important to note that animal studies don’t always predict what will happen in people. And it’s not known for sure whether empagliflozin passes into human breast milk. But if the drug does pass into human breast milk, it may increase the risk of kidney problems in a child who’s breastfed.

If you’re breastfeeding and planning to take Synjardy, talk with your doctor. They may recommend that you stop breastfeeding before starting this drug. Or, your doctor may recommend a diabetes medication for you that’s considered safe to use while breastfeeding.

Here are answers to some frequently asked questions about Synjardy.

If I have type 1 diabetes, can I take Synjardy?

No, Synjardy hasn’t been approved to treat type 1 diabetes. This drug is only approved for use in people with type 2 diabetes. In addition, the manufacturer of Synjardy specifically recommends that the drug shouldn’t be used to treat type 1 diabetes.

Some clinical studies have shown that empagliflozin (one of the active drugs in Synjardy) may be effective in lowering blood sugar levels in people with type 1 diabetes.

But other studies have shown that empagliflozin and other drugs in the same drug class* increase the risk of ketoacidosis in people with type 1 diabetes. This condition is a serious, life threatening complication of diabetes.

More research is needed to know whether it’s safe to use Synjardy to treat type 1 diabetes. If you have questions about treatment options for type 1 diabetes, talk with your doctor.

*A drug class describes a group of medications that work in a similar way.

Is Synjardy a type of insulin?

No, Synjardy isn’t a type of insulin. Instead, Synjardy contains the following two drugs: metformin and empagliflozin. These drugs work in different ways to help lower blood sugar levels in people with type 2 diabetes.

Empagliflozin belongs to a class of drugs* called sodium-glucose cotransporter 2 (SGLT2) inhibitors. It works by making your kidneys eliminate excess sugar from your blood. Your kidneys get rid of this extra sugar by forcing it out through your urine.

Metformin, on the other hand, belongs to a drug class called biguanides. And it’s the only available drug in its class. Metformin works in a few different ways to lower blood sugar levels in people with type 2 diabetes. Primarily, metformin works by:

  • decreasing the amount of glucose that your body absorbs from food
  • increasing your body’s response to insulin
  • reducing the amount of glucose that’s made by your liver

*A drug class describes a group of medications that work in a similar way.

If I’m over the age of 65 years, is it safe for me to take Synjardy?

In general, it’s safe for people ages 65 years and older to take Synjardy. However, some people in this age group may have a higher risk of certain side effects from the drug. These side effects include lactic acidosis, kidney damage and low blood pressure.

These risks are increased because as we age, our kidneys tend to stop working as well as they did when we were younger. One of the drugs in Synjardy, called empagliflozin, needs your kidneys to be working properly in order for it be effective. The other drug in Synjardy, called metformin, is mainly eliminated from your body through your kidneys.

So, if your kidneys aren’t working well, Synjardy may not work as well for you. And you may also have a higher risk of side effects from the drug.

If you’re age 65 years or older and you’re taking Synjardy, your doctor will monitor your kidney function frequently. This allows your doctor to make sure the drug is safe for you to take.

If you’re over age 65 and you have questions about whether Synjardy is safe for you to use, talk with your doctor.

Will Synjardy make me pee more than usual?

Yes, it’s possible that Synjardy could make you urinate more often than usual.

One of the drugs in Synjardy, called empagliflozin, increases the amount of sugar that your kidneys put into your urine. Having large amounts of sugar in your urine pulls water out of your body and into your urine. This can cause you to urinate more often than usual.

Clinical trials showed that about 3% of people who took empagliflozin had to urinate more frequently than usual.

If you have questions about how Synjardy may affect urination, talk with your doctor.

Is Synjardy used to reduce the risk of cardiovascular death?

No, Synjardy isn’t currently approved to reduce the risk of cardiovascular death. Instead, Synjardy is only approved to lower blood sugar levels in adults with type 2 diabetes.

Cardiovascular death is death that’s caused by cardiovascular problems, such as:

One of the active drugs in Synjardy, called empagliflozin, is approved to lower the risk of cardiovascular death. For this use, empagliflozin is given to people with both diabetes and heart disease.

However, Synjardy, which contains a combination of empagliflozin plus metformin, isn’t approved for this use. Synjardy hasn’t been proven effective in reducing the risk of cardiovascular death.

If you’d like to know more about reducing your risk of cardiovascular death, talk with your doctor.

This drug comes with several precautions.

FDA warning: Lactic acidosis

This drug has a boxed warning for lactic acidosis. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Lactic acidosis is a rare but serious side effect of metformin, which is one of the active drugs in Synjardy. Lactic acidosis is a buildup of lactic acid in your blood. This condition is a medical emergency that requires immediate treatment in a hospital.

Certain people have a higher risk of developing lactic acidosis that’s related to using metformin. This includes people with liver or kidney problems and people ages 65 years and older. It also includes people who drink excessive amounts of alcohol and those who take certain other drugs, such as topiramate (Topamax).

Symptoms of lactic acidosis include:

If you have symptoms of lactic acidosis, stop taking Synjardy and call your doctor right away. But if your symptoms feel life threatening, call 911 or have someone take you to the nearest emergency room.

Other precautions

Before taking Synjardy, talk with your doctor about your health history. Synjardy may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Allergy to Synjardy. If you’ve ever had an allergic reaction to Synjardy or any ingredients contained in the drug, you should avoid taking this medication. If you’re not sure about your medication allergies, talk with your doctor.
  • History of chronic genital yeast infections. Empagliflozin, one of the drugs in Synjardy, increases the risk of genital yeast infections. And people with a history of chronic genital yeast infections have a higher risk of this side effect. If you have a history of genital yeast infections, be sure to tell your doctor before starting Synjardy.
  • Liver disease. People with liver problems may have a higher risk of lactic acidosis (increased acid level in your blood) when using Synjardy. Lactic acidosis is a rare, but life threatening side effect of the drug. Talk with your doctor about any liver problems you have before taking Synjardy.
  • Low blood pressure. Synjardy can cause low blood pressure, which may be serious for some people. If you have a history of low blood pressure, be sure to tell your doctor before starting Synjardy.
  • Kidney disease. Some people have had kidney damage after taking Synjardy. People who already have kidney disease may have a higher risk of serious kidney-related side effects if they take Synjardy. Be sure to talk with your doctor about any history of kidney disease before taking Synjardy.
  • Pregnancy. Synjardy is not recommended for use during the second and third trimesters of pregnancy. For more information, please see the “Synjardy and pregnancy” section above.
  • Breastfeeding. Using Synjardy while breastfeeding is not recommended. For more information, please see the “Synjardy and breastfeeding” section above.

Note: For more information about the potential negative effects of Synjardy, see the “Synjardy side effects” section above.

Do not use more Synjardy than your doctor recommends. For some drugs, doing so can lead to unwanted side effects or overdose.

Overdose symptoms

In some people, overdosing on metformin (one of the drugs in Synjardy) may cause lactic acidosis. (With lactic acidosis, you have an increased acid level in your blood). Symptoms of lactic acidosis include:

What to do if you think you’ve overdosed

If you think you’ve taken too much Synjardy, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Synjardy from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Synjardy tablets should be stored at room temperature (77°F or 25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms. Be sure to store Synjardy out of reach of children.

Disposal

If you no longer need to take Synjardy and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Synjardy is approved to improve glycemic control in adults with type 2 diabetes, as an adjunct to diet and exercise.

Mechanism of action

Synjardy contains two active drug ingredients: metformin and empagliflozin.

Metformin lowers both basal and postprandial blood glucose by decreasing hepatic glucose production and decreasing intestinal absorption of glucose. Metformin also improves insulin sensitivity via increased peripheral glucose uptake and utilization.

Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. Inhibiting SGLT2 reduces renal glucose reabsorption in the proximal convoluted tubule. It also increases renal excretion of both glucose and urine.

Pharmacokinetics and metabolism

Metformin has an absolute bioavailability of approximately 50% to 60%. Consumption of food slightly decreases and delays the drug’s absorption, but the clinical relevance of this isn’t known.

Metformin reaches steady-state plasma concentrations within 24 to 48 hours, and it doesn’t significantly bind to plasma proteins. Metformin is excreted unchanged in urine without undergoing hepatic metabolism. Metformin has an elimination half-life of 6.2 hours. Approximately 90% of the dose is eliminated via renal excretion.

Empagliflozin concentrations peak approximately 90 minutes after oral administration. A high-fat and high-calorie meal slightly reduces area under the curve (AUC) and maximum concentration (Cmax), but these decreases aren’t considered clinically relevant.

The plasma protein binding of empagliflozin is high, at 86.2%. Empagliflozin undergoes extensive hepatic glucuronidation via UGT2B7, UGT1A3, UGT1A8, and UGT1A9.

Empagliflozin is eliminated in both the feces and urine, at approximate rates of 41.2% and 54.4%, respectively.

Contraindications

Synjardy is contraindicated in people with:

  • a history of serious hypersensitivity reaction to empagliflozin, metformin, or any other component of Synjardy
  • acute or chronic metabolic acidosis, including diabetic ketoacidosis
  • moderate to severe renal impairment (eGFR less than 45 mL/min/1.73 m2), end-stage renal disease, or those who are on dialysis

Storage

Synjardy should be stored at room temperature (77oF/25oC). Temperature excursions of 59°F to 86°F(15°C to 30°C) are permitted.

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 other 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.