Empagliflozin (also called Jardiance)

Have a sick day plan

If you're unwell, stop taking empagliflozin. Taking empagliflozin when you are unwell increases your risk of high ketone levels, which can cause a serious but rare side effect called diabetic ketoacidosis (DKA). Only restart your empagliflozin when you are well AND you're eating and drinking normally.

If you have nausea (feeling sick), vomiting (being sick) or tummy pain, you need to have a finger prick blood test immediately to check your ketone levels. This can be done at your GP clinic, after hours medical centre or hospital.

Tell your healthcare team before making any big changes to your diet

If you start eating less or go on a keto (low carbohydrate) diet or are fasting, this may increase your risk of ketoacidosis.

Keep your genitals clean

Because you will pee more and have more glucose in your urine, you have a higher risk of getting thrush or groin infections.

Regular washing helps prevent this. Women should wash their groin and vulval area twice a day and men should wash their penis, foreskin and groin area at least once a day.

Prepare before an operation or a procedure

If you are going to have an operation or a procedure where you will need to stop eating for 12 hours or more such as a colonoscopy or dental surgery, ask your healthcare team when you should stop and restart your empagliflozin. You may need to stop your empagliflozin 3 days before the operation or procedure.

Fasting during Ramadan

If you are fasting during Ramadan and are still getting enough carbohydrates, you can keep taking empagliflozin. It's important to talk to your healthcare provider about getting enough carbohydrates and drinking plenty of water while taking empagliflozin. It's not recommended to start empagliflozin as a new medicine immediately before or during Ramadan.

Are you pregnant, trying for a baby or breastfeeding?

It is important to talk to your GP or nurse as soon as possible if you are trying to get pregnant, are pregnant or breastfeeding. You may need to change to another diabetes medicine.

Tell your healthcare team if you are taking any other medicines

Empagliflozin may interact with some medicines and herbal supplements, so check with your doctor or pharmacist before starting empagliflozin and before starting any new medicines.

Exercising and diet

It's important to keep up your healthy diet and exercise while you're taking empagliflozin. Empagliflozin works best when used in combination with good nutrition and regular exercise. 

It's a good idea to cut down on foods with added sugar if you have diabetes. However, ask your healthcare provider for advice before starting a low-calorie, reduced carbohydrate or keto diet. Having too few carbohydrates in your diet while you are taking empagliflozin may increase your risk of ketoacidosis.

Note: You should avoid a low carbohydrate (ketogenic or keto) diet while you are taking empagliflozin. This may increase your risk of ketoacidosis. 

Marathon or long distance runners

Being dehydrated and not eating enough carbohydrates can lead to high ketone levels, which can cause a serious but rare side effect called ketoacidosis. If you are going to run a long distance or marathon while you are taking empagliflozin, it's important to let your healthcare provider know. You may need to stop empagliflozin the day before the marathon and restart 24 hours or so afterwards when you are well hydrated and eating normally. 

Blood glucose testing with a glucometer 

Empagliflozin won't cause low blood glucose levels (hypoglycaemia) unless you're also taking insulin and/or sulfonylureas (eg, glipizide or gliclazide tablets). So if you are also taking insulin and/or sulfonylureas, you need to check your glucose levels regularly with a glucometer to make sure they are safe.

If you're not on insulin or sulfonylureas, you may still choose to check your glucose levels to see the effects of empagliflozin. It's also important to check your HbA1c 3 months after starting empagliflozin.

You may need a blood glucose test and a ketone test if you are unwell with vomiting (being sick) or diarrhoea (runny poo). Ask your healthcare provider for advice. Read more about diabetes blood glucose testing and diabetes sick day plan.

• Peeing (urinating) more often than usual
• Pain or burning feeling when you pee
• Mild skin rash or itchy skin
• Feeling dizzy

• These are quite common when you start taking empagliflozin, but they are usually mild and go away with time.
• Talk to your healthcare provider if these side effects cause you problems or don’t go away.
• Don’t drink alcohol if you are feeling dizzy, this can increase your risk of falls.

Signs and symptoms of diabetic ketoacidosis (DKA) such as:

• being sick (vomiting)
• feeling very thirsty (dehydrated)
• being confused or unusually tired or sleepy
• tummy (abdominal) pain
• sweet-smelling breath
• deep or fast breathing

• This is a rare but serious side effect of empagliflozin.
• You are at increased risk if you are dehydrated or have a sudden illness, drink large amounts of alcohol, have just had surgery, have reduced your calorie intake, are on a low carbohydrate diet or if your insulin requirements have increased. 
• If you get these signs and symptoms: Stop taking empagliflozin and contact your healthcare provider or Healthline 0800 611 116 immediately and tell them you are taking empagliflozin.

Signs of Fournier’s gangrene such as:

• swelling, pain, itching or tenderness in or around your vagina, penis, testicles or bottom
• changes to the colour of your skin, such as redness or darkened areas around your vagina, penis, testicles or bottom
• fever or high temperature
• general unwellness or tiredness

• This is a rare but serious side effect of empagliflozin.
• If you get these signs and symptoms: Stop taking empagliflozin, contact your healthcare provider or Healthline 0800 611 116 immediately and tell them you're taking empagliflozin.
• Read more about Fournier’s gangrene.(external link)