Daily Medication Pearl: Empagliflozin and Metformin (Synjardy) for Type 2 Diabetes Mellitus

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

Medication Pearl of the Day: Empagliflozin and Metformin (Synjardy)

Indication: Synjardy is a combination of empagliflozin—a sodium-glucose co-transporter 2 (SGLT2) inhibitor—and metformin hydrochloride (HCl)—a biguanide—indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Insight:

  • Dosing: The maximum recommended dose is 12.5 mg empagliflozin and 1000 mg metformin HCl twice daily. Take twice daily with meals, with gradual dose escalation to reduce the gastrointestinal adverse effects (AEs) due to metformin. Not to start with GFR <45.
  • Dosage form: 5 mg empagliflozin/500 mg metformin HCl 5 mg empagliflozin/1000 mg metformin HCl 12.5 mg empagliflozin/500 mg metformin HCl 12.5 mg empagliflozin/1000 mg metformin HCl
  • AEs: Most common AEs associated with empagliflozin (5% or greater incidence) were urinary tract infection and female genital mycotic infections.
  • Mechanism of action: Empagliflozin is an inhibitor of SGLT2. By inhibiting SGLT2, empagliflozin reduces renal reabsorption of filtered glucose, lowers the renal threshold for glucose, and thereby increases urinary glucose excretion. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
  • Manufacturer: Boehringer Ingelheim

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