How does this medication work? What will it do for me?
Empagliflozin belongs to the class of medications called oral antihyperglycemic agents. It works in the kidneys to increase the amount of glucose removed from the body by the kidneys.
Empagliflozin is used alone or in combination with other medications for people with type 2 diabetes to control their blood glucose. This medication should be used as part of an overall diabetes management plan that includes a diet and exercise program.
Empagliflozin is also used for people with type 2 diabetes who also have cardiovascular disease. It is used in addition to diet, exercise, and other medications to reduce the risk of dying from cardiac disease. It is also used in addition to other medications to treat chronic (long-lasting) heart failure.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each pale yellow, round, biconvex and bevelled-edged, film-coated tablet, debossed with "S10" on one side and the Boehringer Ingelheim company symbol on the other side, contains 10 mg of empagliflozin. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, macrogol, microcrystalline cellulose, titanium dioxide, talc, and yellow ferric oxide.
Each pale yellow, oval, biconvex, film-coated tablet, debossed with "S25" on one side and the Boehringer Ingelheim company symbol on the other side, contains 25 mg of empagliflozin. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, macrogol, microcrystalline cellulose, titanium dioxide, talc, and yellow ferric oxide.
How should I use this medication?
The usual starting dose of empagliflozin is 10 mg taken by mouth once a day. For people with type 2 diabetes, depending on how effectively it reduces your blood glucose, your doctor may increase the dose to 25 mg taken once a day.
Empagliflozin may be taken at any time of the day, with or without food. The tablet must be swallowed whole. Do not cut or chew the tablets.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is less than 12 hours until your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to empagliflozin or any ingredients of the medication
- have severely decreased kidney function or end-stage kidney disease, or are on dialysis
This medication should not be taken by people who have type 1 diabetes.
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- increased urination
- straining or pain when urinating
- symptoms of yeast infection of the penis (e.g., red, swollen, itchy head of penis; unpleasant odour; discharge under foreskin; pain passing urine or during sexual activity)
- symptoms of vaginal yeast infection (e.g., itching, burning, soreness, whitish-grey discharge)
- unusual thirst
- weight loss
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- low blood pressure (e.g., dizziness or fainting when rising from a sitting or lying position)
- signs of dehydration (e.g., decreased urine, dry skin, dry and sticky mouth, sleepiness, dizziness, headache, thirst, confusion)
- signs of infection that has spread from the urinary tract (e.g., fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine, change of urine colour)
- symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
- symptoms of a urinary tract or kidney infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain, fever or chills, cloudy or foul-smelling urine, blood in the urine)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- pain, redness, or swelling in and around the anus or genitals, especially if accompanied by fever, tiredness, or weakness
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- signs of sepsis (blood infection; e.g., fever, dizziness, chills, very high or very low body temperature, low blood pressure, pounding or rapid heartbeat, rapid and shallow breathing)
- symptoms of diabetic ketoacidosis (DKA; e.g., difficulty breathing, extreme thirst, vomiting, nausea, loss of appetite, stomach pain, confusion, unusual tiredness)
- signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Diabetic ketoacidosis (DKA): Empagliflozin has been associated with DKA. This is a potentially life-threatening condition caused by not having enough insulin in the blood to use the glucose in the bloodstream. When this happens, the body starts to burn ketones for fuel and can make the blood acidic. This condition is more likely to develop if you are following a very low carbohydrate diet, are dehydrated, or have consumed a large amount of alcohol. Symptoms of DKA include:
- difficulty breathing
- abdominal pain
- loss of appetite
- excessive thirst
- unusual fatigue or sleepiness
If you experience these symptoms, get immediate medical help.
Cholesterol: Empagliflozin can cause increased levels of low-density lipoprotein (LDL), a type of cholesterol in the bloodstream. If you are at risk of developing high cholesterol or you have high cholesterol levels before starting empagliflozin, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Your doctor will monitor your cholesterol levels regularly while you are taking this medication.
Drowsiness/reduced alertness: Empagliflozin may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.
Fluid and electrolyte balance: Empagliflozin causes increased urine production that may cause the levels of electrolytes such as potassium, sodium, magnesium, chloride, and calcium in the blood to change while taking this medication. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Your doctor will do blood tests regularly to monitor the levels of these electrolytes in your blood while you are taking this medication.
Glucose control: When empagliflozin is taken along with other medications for diabetes, glucose levels may drop too far, causing confusion, cold sweats, cool and pale skin, headache, fast heartbeat, or weakness. Your doctor may suggest decreasing the dose of your other medications when you first start taking empagliflozin. If you take other medications for diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney function: Empagliflozin may cause a decrease in kidney function. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Low blood pressure: Empagliflozin causes an increased amount of fluid to be removed from the body through the urine. As a result, it can cause decreases in blood pressure that may cause dizziness, especially when rising from a sitting or lying position. To reduce the possibility of dizziness or fainting, rise slowly from sitting or lying down.
Surgery: This medication should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on this medication after surgery once you are eating and drinking again and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.
Urinary tract infection: This medication increases the risk of developing urinary tract infections. If you experience symptoms of a urinary tract infection, such as increased need to urinate, burning sensation when urinating, cloudy urine, strong-smelling urine, or pelvic pain, contact your doctor.
Yeast infections: There is an increased risk of developing genital or vaginal yeast infections when taking empagliflozin, as a result of increased glucose in the urine. This is more likely to occur for uncircumcised men and for people who have a history of yeast infections.
Pregnancy: This medication should not be used during pregnancy as the potential risk to the developing baby may be serious. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if empagliflozin passes into breast milk. If you are breast-feeding and are taking this medication, it may have serious adverse effects on your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.
Seniors: Seniors are at an increased risk of experiencing urinary tract infections and decreases in blood pressure while taking this medication.
What other drugs could interact with this medication?
There may be an interaction between empagliflozin and any of the following:
- acetylsalicylic acid (ASA)
- androgens (e.g., testosterone)
- antimalarials (e.g., hydroxychloroquine, quinine)
- atypical antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
- corticosteroids (e.g., beclomethasone, cortisone, dexamethasone, hydrocortisone, prednisone)
- other diabetes medications (e.g., acarbose, glyburide, insulin, linagliptin, lixisenatide, metformin, rosiglitazone)
- diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
- estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
- hepatitis C antivirals (e.g., elbasvir, grazoprevir, ledipasvir, sofosbuvir, velpatasvir)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
- quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
- valproates (e.g., divalproex, sodium valproate, valproic acid)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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