Empagliflozin (also called Jardiance)

In Aotearoa New Zealand empagliflozin is available as tablets (10 mg and 25 mg).

• Diabetes: The usual starting dose is 10 mg once a day. Depending on your blood glucose levels, your doctor may increase your dose to 25 mg once a day.
• Heart Failure: The usual dose is 10 mg once a day.

Always take your empagliflozin exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

• Timing: Take empagliflozin once a day, at the same time each day. Swallow your tablets with a drink of water. You can take empagliflozin with or without food. 
• Drink enough water so you don't get thirsty: When you start taking empagliflozin, you may pee more but this gets better over a few weeks. If you’ve been told to limit how much you drink, talk to your healthcare team.
• Avoid or limit alcohol while you are taking empagliflozin: It may affect your blood glucose control and increase your risk of side effects. Drinking alcohol very often or drinking a lot of alcohol over a short time (binge drinking) can affect your blood glucose and lead to high ketone levels. This can cause a serious but rare side effect called ketoacidosis. 
• Missed dose: If you forget your dose, take it as soon as you remember that day unless it is 12 hours or less until your next dose is due. If that's the case, skip the forgotten dose and take your next dose at the usual time.
• Don't run out of tablets: Empagliflozin works best when taken every day. Contact your healthcare team every 3 months for a new prescription.

Here are some things to know when you're taking empagliflozin. Other things may be important as well, so ask your healthcare provider what you should know about.

You are at increased risk of fungal genital infections (thrush)

Empagliflozin causes you to pee more and have more glucose in your urine, which increases your risk of getting thrush around the vagina or penis. Germs (bacteria and fungus) like to grow in body fluids with a high sugar content. As your blood glucose level decreases, this tends to settle.

Wash your genital area with warm water using non-perfumed soap and avoid wearing tight underwear to reduce your risk. Also any drops of pee left behind on your penis or vagina need to be removed.

• If you have a vagina you should wash your vulval area twice a day. After peeing, rinse the area with water and then pat dry. If rinsing isn't possible, pat dry carefully with toilet paper.
• If you have a penis you should wash your groin area at least once a day. After peeing, rinse your penis with water and then pat dry. If rinsing isn't possible, pat dry carefully with toilet paper. If you have a foreskin, pull this back before you pee, to avoid drops of urine spilling into the foreskin fold.

If you get any irritation or itching, pain or swelling in your genital area or around your bottom, contact your healthcare provider immediately. It's important to treat this early.

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.

Being dehydrated and not eating enough carbohydrates can cause serious side effects

Being dehydrated and not eating enough carbohydrates can lead to high ketone levels, which can cause a serious but rare side effect called ketoacidosis.

• Tell your healthcare team before making any big changes to your diet: It's a good idea to cut down on foods with added sugar if you have diabetes. However, having too few carbohydrates in your diet while you're taking empagliflozin may increase your risk of ketoacidosis. Tell your healthcare team if you start eating less, go on a keto (low carbohydrate) diet or if you're fasting.
• Fasting during Ramadan: If you're 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.
• Marathon or long distance runners: If you're going to run a long distance or marathon while you're 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. 

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 (eg, 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.

Are you pregnant, trying for a baby or breastfeeding?

It is important to talk to your healthcare provider 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.

Like all medicines, empagliflozin can cause side effects, although not everyone gets them. Please note, empagliflozin does not cause weight gain and usually helps you lose weight.