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Empagliflozin

Sounds like 'empa-gli-FLOW-zin'

Key points about empagliflozin

Empagliflozin is used to treat type 2 diabetes.
Empagliflozin is also called Jardiance.
Find out how to take it safely and possible side effects.

Empagliflozin is used to treat type 2 diabetes and protect your kidneys and heart. Read more about type 2 diabetes.

Empagliflozin lowers your blood glucose and blood pressure by helping your kidneys get rid of glucose, salt and fluid when you pass urine (pee). Empagliflozin has other benefits such as weight loss, helping your kidneys work better and lowering your chance of having a heart attack or stroke. It may also help you to live longer.

Empagliflozin can be used alone, or with other diabetes medicines (such as metformin), to help manage your glucose levels along with healthy eating and regular exercise. Empagliflozin is also available as a combined tablet with metformin and then it is called Jardiamet.

Empagliflozin lowers your blood glucose and blood pressure by helping your kidneys get rid of glucose, salt and fluid when you pass urine (pee). Empagliflozin has other benefits such as weight loss, helping your kidneys work better, lowering your chances of having a heart attack and developing heart failure. It may also help you to live longer. Read more about how to take empagliflozin.

In Aotearoa New Zealand empagliflozin is available as tablets (10 mg and 25 mg).
The usual starting dose is 1 tablet (10 mg) once a day.
Depending on your blood glucose levels, your doctor may increase your dose to 25 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. Your doctor may advise how much you should drink, talk to your healthcare team about this if you are not sure.
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 in a short time period (binge drinking) can affect the control of your diabetes 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, take your next dose at the usual time and skip the forgotten dose.
Don't run out of tablets: Empagliflozin works best when taken every day. See your healthcare team every 3 months for a new prescription.

Video: How to take empagliflozin (Jardiance and Jardiamet)

(Healthify and PHARMAC, 2022)
View descriptive transcript in English

If you have type 2 diabetes, you will probably need to take empagliflozin for the rest of your life. The benefits of reducing your blood glucose only continue for as long as you take your empagliflozin. However, losing weight and improved blood glucose control may lead to the possibility of stopping empagliflozin.

Like all medicines, empagliflozin can cause side effects, although not everyone gets them.

Side effects	What should I do?
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.
Signs and symptoms of diabetic ketoacidosis (DKA) such as: being sick (vomiting) feeling very thirsty (dehydrated) being confused or unusually tired stomach 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 experience a sudden illness, 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 and tell your healthcare provider or Healthline 0800 611 116 immediately and tell them you are taking empagliflozin. Read more about Fournier’s gangrene.(external link)
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.(external link)

Empagliflozin is funded or subsidised for people with high-risk type 2 diabetes who meet one of the following criteria. This means you will only be required to pay a co-payment of $5 for a 3-month supply of empagliflozin.

If you are of Māori or Pacific ethnicity.
If you have pre-existing cardiovascular disease such as angina, myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, transient ischaemic attack, ischaemic stroke, peripheral vascular disease), congestive heart failure or familial hypercholesterolaemia.
If you have a 5-year cardiovascular disease risk of 15% or greater.
If you have a high lifetime cardiovascular risk due to being diagnosed with type 2 diabetes during childhood or as a young adult.
If you have diabetic kidney disease.
If your target HbA1c (of 53 mmol/mol or less) has not been achieved despite the regular use of at least 1 diabetes medicine such as metformin, vildagliptin or insulin, for at least 3 months.
If you have been taking empagliflozin in the past, and if your HbA1c was above 53 mmol/mol before you started empagliflozin but with continued empagliflozin it is now on target.

If you do not meet the above criteria, you will have to pay the full amount (about $85 per month) for your supply of empagliflozin. Note: Prices may vary between pharmacies.

Have a sick day plan

If you are 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 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 at either your GP clinic, after hours medical centre or hospital to check your ketone levels.

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 per day.

Prepare before an operation or a procedure

If you are going to have an operation or a procedure such as a colonoscopy, ask your healthcare team when you should stop and restart your empagliflozin. You may need to stop your empagliflozin 2 or 3 days before the operation.

Can I take empagliflozin during the fasting month of Ramadan?

If you are not fasting all day and are still getting enough carbohydrates, you can continue taking empagliflozin during the fasting month of Ramadan. It is important to talk to your health professional about getting enough carbohydrates and drinking plenty of water while taking empagliflozin.

Are you pregnant?

Empagliflozin is not recommended in pregnancy. It is not clear whether empagliflozin can harm an unborn baby. If you think you might be pregnant or are planning to have a baby, talk to your healthcare provider.

Woman of child-bearing age who are taking empagliflozin should use reliable contraception to prevent pregnancy. Empagliflozin does not interfere with any type of contraception, including the combined pill or emergency contraception.

Are you breastfeeding?

Do not breastfeed if you are taking empagliflozin. It is not known if empagliflozin passes into breast milk so there is a possibility that your baby may be affected. Talk to your healthcare professional about what's best for you and your baby. They may prescribe a different medicine, particularly while you're breastfeeding a newborn or premature baby..

Tell your healthcare team if you are taking any other medicines

Empagliflozin may interact 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 is important to continue your healthy diet and exercise while you are 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 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 is 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.

Weight gain myth

Empagliflozin does not cause weight gain and usually helps you lose weight.

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

If you are not on insulin or sulfonylureas, you may still choose to check your glucose levels to see the effects of empagliflozin. It is 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.

While you are taking empagliflozin, your doctor will check your HbA1c levels regularly (every 3–6 months) to assess your blood glucose control. If your HbA1c levels are raised, your doctor may increase your dose of empagliflozin or add another diabetes medicine.

You may also choose to check your glucose levels with a glucometer to monitor trends in your blood glucose. It is important to remember that you may not have any symptoms of diabetes, so you won't necessarily feel any different when you take empagliflozin. This does not mean that empagliflozin is not working, and it's important to keep taking it.

Even if you notice only a small improvement in your glucose levels, empagliflozin will still be having a protective effect on your heart and glucose levels. Your doctor will likely continue your empagliflozin and increase or add other medicines to help lower your glucose levels.

Jardiance(external link) Medsafe Consumer Information, NZ

Empagliflozin factsheets: Find out how to take it safely and the possible side effects. Translations are available in 9 languages.
English [PDF, 213 KB] Te reo Māori [PDF, 1 MB] Samoan [PDF, 823 KB] Tongan [PDF, 921 KB] Chinese (simplified) [PDF, 732 KB] Chinese (traditional) [PDF, 867 KB]	Cook Islands Māori [PDF, 1.5 MB] Hindi [PDF, 1.8 MB] Niuean [PDF, 321 KB] Tokelauan [PDF, 829 KB] Tuvaluan [PDF, 1.3 MB]