Synjardy
Synjardy is a tablet containing empagliflozin (an SGLT2 inhibitor) and metformin (a biguanide). It helps lower blood sugar in people with Type 2 diabetes when used with a balanced diet and regular exercise. Synjardy can also help lower the risk of serious problems in adults with Type 2 diabetes who have heart disease, heart failure, or chronic kidney disease (CKD). Immediate-release tablets (IR) are for people 10 years and older and are taken twice a day. The extended-release tablets (XR) are only for adults and are taken once a day. Side effects include urinary tract infections and genital yeast infections.
What is Synjardy?
What is Synjardy used for?
- Type 2 diabetes
- Lowering the risk of death due to heart problems in adults with Type 2 diabetes and heart disease
- Lowering the risk of hospitalization and death due to heart problems in adults with Type 2 diabetes and heart failure
- Lowering the risk of worsening kidney problems, hospitalization, and death due to heart problems in adults with Type 2 diabetes and chronic kidney disease (CKD)
How Synjardy works
Synjardy is a combination of two medications:
- Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. It blocks the SGLT2 protein in the kidneys. This stops sugar and sodium (salt) from absorbing back into your body through the kidneys. As a result, a few things happen.
- Sugar goes into your urine instead. This helps get rid of extra sugar in your blood, which lowers your blood sugar levels.
- By stopping your body from reabsorbing sodium, the heart can fill with blood more easily. The heart can also pump blood better to the rest of the body. This lessens stress on the heart. And with blood flowing better through the kidneys, it helps slow down CKD from getting worse.
- Metformin is a biguanide. It lowers the amount of sugar that your liver makes. It also lowers the amount of sugar that's absorbed through your gut from food you eat. And, it helps your body respond better to insulin (your cells can take up sugar from the blood and use it as energy better).
Drug facts
Side effects of Synjardy
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood sugar (up to 16%)
- Urinary tract infection (up to 9%)
- Upper respiratory tract infection or common cold (up to 8%)
Note: Side effect percentages were reported by adults taking empagliflozin, metformin, and a sulfonylurea.
Less Common Side Effects
- Vaginal yeast infection in females
- Genital fungal infection in males
- Joint pain
- More urination
- Nausea
- Vomiting
- Diarrhea
- Excessive gas
- Belly discomfort
- Indigestion
- Lack of energy
- Headache
Synjardy serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Buildup of lactic acid: confusion, feeling weak or tired, fast heartbeat, rapid breathing, no appetite, nausea, vomiting, stomach pain, muscle pain
- Ketoacidosis (high ketone levels in the blood): shortness of breath, vomiting, belly pain, dry skin, dry mouth, feeling very tired, fruity-smelling breath
- Sudden kidney problems: urinating less than usual
- Low blood pressure: dizziness, lightheadedness, confusion
- Serious genital infection: pain, swelling, or redness in the genital area; fever; weakness
- Severe allergic reaction: rash, blisters, sores, trouble breathing, swelling
The following Synjardy side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
- Diabetic ketoacidosis (DKA)—increased thirst or amount of urine, dry mouth, fatigue, fruity odor to breath, trouble breathing, stomach pain, nausea, vomiting
- Genital yeast infection—redness, swelling, pain, or itchiness, odor, thick or lumpy discharge
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection or redness, swelling, tenderness, or pain in the genitals, or area from the genitals to the back of the rectum
- Low vitamin B12 level—pain, tingling, or numbness in the hands or feet, muscle weakness, dizziness, confusion, trouble concentrating
- New pain or tenderness, change in skin color, sores or ulcers, infection of the leg or foot
- Urinary tract infection (UTI)—burning when passing urine, passing frequent small amounts of urine, bloody or cloudy urine, pain in the lower back or sides
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Synjardy
Pros
- Combines two medications into one tablet for convenience
- Not likely to cause weight gain
- Available in both immediate-release and extended-release versions
- Immediate-release tablets are okay for children 10 years and older to take
Cons
- Need to take with food
- Might cause urinary tract infections or genital yeast infections
- Not safe for people with severe kidney problems or on dialysis
- Not approved for people with Type 1 diabetes
Pharmacist tips for Synjardy
- Take Synjardy with food. This helps lower the risk of side effects like diarrhea, nausea, vomiting, and belly pain.
- For Synjardy XR tablets: Swallow the tablets whole. Don't cut, crush, dissolve, or chew the tablets. Otherwise, it can affect how the medication gets absorbed into your body. You might see pieces of the tablet in your stool, which is normal.
- Be sure to drink enough fluids while taking Synjardy. You could get dehydrated if you don't drink enough fluids, are sick, or have side effects like vomiting or diarrhea. Call your care team if you feel dehydrated, dizzy, or lightheaded while taking Synjardy.
- Synjardy can raise your risk of genital yeast infections or urinary tract infections. Practice good hygiene to lower your risk of these infections. Tell your care team right away if you have pain while urinating, cloudy or bloody urine, or belly pain. Also call them if you have any genital itching, redness, or discharge. Your care team can get you the treatment you need if you have an infection.
- Tell your prescriber ahead of time if you have a surgery or procedure coming up. They'll tell you if you need to take a break from Synjardy a few days before and when it's safe to take it again. Taking Synjardy while you're fasting for a procedure can raise your risk of having too much acid build up in the blood. This can be harmful.
- If you need an imaging test done, talk to your prescriber beforehand. Also tell the imaging team you're taking Synjardy. Some tests use contrast dyes that can affect your kidneys for a short while. This can raise the risk of a serious problem called lactic acidosis while you're taking Synjardy. Follow your care team's instructions about when to stop and restart the medication to stay safe.
- Stop taking Synjardy and get medical help right away if you have signs of ketoacidosis. These signs include feeling very tired, fruity breath, or trouble breathing. Also stop taking it and call for help if you feel dizzy, confused, a fast heartbeat, muscle pain, or stomach pain. These can be signs of lactic acidosis. Both problems come from having too much acid in the blood and can be dangerous.
- Follow a healthy and balanced diet and exercise regularly while you're taking Synjardy. This helps keep your blood sugar under control. It also helps improve your overall health. Talk to your care team about a diet and exercise plan that works best for you.
Common questions about Synjardy
In a study, people with Type 2 diabetes who took Jardiance (empagliflozin) and metformin together — the two ingredients in Synjardy — lost some weight. On average, they lost about 2% to 3% of their starting weight after about 6 months of treatment. Keep in mind that Synjardy is not approved by the FDA specifically for weight loss. If you want to lose weight, talk to your primary care provider about safe options.
You might start to see better blood sugar levels within the first week of starting Synjardy. But it can take a few weeks or months to see steady changes and possibly a lower A1C (average blood sugar level over 3 months). Keep track of your blood sugar numbers and share them with your prescriber. This helps you and your care team see how well Synjardy is working for you.
It can take up to 4 days for most of Synjardy to leave your body after one dose. This time frame is estimated from the half-life of the medication. It can stay in your system for a longer time if you have kidney problems or are older. In these cases, the kidneys might not work as well to get rid of the medication from the body. Ask your prescriber if you have questions about how long Synjardy stays in your body.
No. Synjardy XR (the extended-release version) is only approved to be taken once a day with your morning meal. It lasts throughout the day. Taking Synjardy XR twice a day might raise your risk of side effects like an upset stomach or low blood sugar. But note that Synjardy (the immediate-release version) is taken twice a day. Take your medication as prescribed. Don't change how you take it without talking to your prescriber first.
No, Synjardy isn't a GLP-1 medication. GLP-1 medications are a class of medications that can be helpful for diabetes. Some also have heart and kidney benefits, like Synjardy. But Synjardy has different types of medications in it. Synjardy contains empagliflozin, which is an SGLT2 inhibitor, and metformin, which is a biguanide. These three types of medications all work in different ways to lower blood sugar.
It's not a good idea to cut Synjardy or Synjardy XR tablets in half. They don't have a score line (an indented line down the middle marking where you can cut it). In general, it's not recommended to cut unscored tablets. You might not cut the tablet into even halves, which means you might not take the right dose. And, you could hurt yourself. What's more, the manufacturer says to swallow Synjardy XR tablets whole. If you have trouble swallowing the tablets whole, talk to your prescriber for more guidance.
Don't take Synjardy with metformin unless your prescriber says it's okay. Synjardy contains metformin as one of its ingredients. Taking additional metformin can raise your risk of side effects like diarrhea and nausea. Taking too much metformin can also raise the risk of a serious problem called lactic acidosis. This happens when there's too much lactic acid in your body, which can be life-threatening. If you feel like Synjardy isn't working well to control your blood sugar, talk to your prescriber. They can help decide if you need any changes to your treatment plan.
Synjardy and Synjardy XR are two different formulations of the same brand medication. Both contain empagliflozin and metformin. And they both help lower blood sugar with some heart and kidney benefits for certain people. The main difference is how often you take them. Synjardy is the immediate-release version that's taken twice a day. But Synjardy XR is the extended-release version. It's taken once a day since it lasts longer in your body. Another difference is age: Synjardy can be taken by people 10 years and older, but Synjardy XR is only for adults. Talk to your prescriber to see which version of Synjardy is best for you.
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Risks and warnings for Synjardy
Synjardy can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Lactic acidosis
- Risk factors: Kidney problems | Liver problems | Heart failure | Low oxygen | Age 65 or older | Surgery or procedure that requires fasting | Drinking a lot of alcohol | Imaging procedure using contrast dye | Taking certain medications that affect the kidneys | Taking medications that raise the risk of lactic acidosis
Synjardy has metformin in it, which has a risk of causing a rare but serious condition called lactic acidosis. This happens when there's too much lactic acid builds up in your blood. If it isn't treated, it can lead to life-threatening health problems.
Before starting Synjardy, let your prescriber know about your medical conditions and medications. They can check if you're at risk for lactic acidosis. In particular, your risk is higher if you have kidney problems. So, your prescriber will check your kidney health with blood tests before you start. This helps make sure the medication is safe for you.
Get emergency medical help right away if you have fast breathing, trouble breathing, an uneven heartbeat, stomach pain, muscle pain, or feel very tired or weak. These can be signs that you have too much lactic acid in your blood.
Ketoacidosis
- Risk factors: Not eating for a long time | Surgery | Sudden fever | Ketogenic diet (keto diet) | Dehydration | Pancreatic problems | Type 2 diabetes | Lowering your insulin dose or missing insulin doses | Alcohol use disorder
Some people with diabetes who took empagliflozin, one of the ingredients in Synjardy, had a serious condition called diabetic ketoacidosis (DKA). This happens when your body uses fat for energy instead of sugar. This leads to a buildup of acidic ketones in the blood. And when your blood gets too acidic, it can be very dangerous.
Ketoacidosis can happen even if your blood sugar isn't very high. This includes when you have a fever, eat less than usual, drink a lot of alcohol, or just had surgery.
Stop taking Synjardy and get medical help right away if you notice signs of ketoacidosis. These signs include a dry mouth, fruity-smelling breath, feeling tired, vomiting, stomach pain, and trouble breathing.
Low fluids in the body (leading to low blood pressure, dehydration, or kidney problems)
- Risk factors: People age 65 years and older | History of kidney problems | Taking certain water pills
Synjardy can cause your body to lose fluid. If you lose too much fluid, it can lead to dehydration or low blood pressure. In some cases, it has also caused kidney damage, which might need hospital care or dialysis.
Before you start Synjardy, tell your prescriber about your medical history. You might be at risk of having low fluid levels and related problems if you have kidney problems or are older. If you're at risk, your prescriber might do blood and urine tests to make sure the medication is safe for you.
Let your care team know if you feel dizzy or confused or if you're urinating less than usual while you're taking Synjardy. These could be signs of dehydration, low blood pressure, or kidney problems.
Genital infections and urinary tract infections
- Risk factors: History of genital yeast infections | History of urinary tract infections (UTIs)
Synjardy might raise your risk of getting urinary tract infections (UTIs), including those that get to the kidneys. It can also make it easier to get a genital infection, like a yeast infection. In rare cases, genital infections can be very serious and might need hospital care.
Tell your care team right away if you have signs of a UTI or genital infection. These signs can include pain while urinating, cloudy urine, itching in the genital area, or back pain. Get medical help right away if you have signs of a more serious infection. Watch for pain, swelling, or redness in the genital area, along with a fever or feeling weak.
Low blood sugar (hypoglycemia) when taken with certain diabetes medications
- Risk factors: Changes in diet and exercise | Taking other medications for diabetes, especially insulin or sulfonylureas (like glipizide) | Children
You could have low blood sugar if you take Synjardy with insulin or sulfonylureas (like glipizide). Your prescriber might need to change the dose of your diabetes medications to help keep your blood sugar from getting too low.
It's important to know the signs of low blood sugar. These can include feeling shaky, very hungry, confused, weak, nervous, sweaty, or having a fast heartbeat. Always carry glucose tablets or other fast-acting carbohydrates with you, just in case. If you have low blood sugar, treat it with fast-acting carbs right away. Talk to your care team if you're worried about low blood sugar while taking this medication.
Leg and foot amputations
- Risk factors: Previous amputation | Peripheral artery disease (narrowed blood vessels) | Diabetic foot ulcers or infections
In rare cases, some people who took empagliflozin (one of the ingredients in Synjardy) needed a foot or leg amputation. In studies, this was usually a toe or foot but sometimes it was above or below the knee. The most common reasons for amputation were peripheral artery disease and diabetic foot ulcers. The risk might be higher for people with these problems and those who've had an amputation before.
Pay close attention to your legs and feet while taking Synjardy. Tell your care team if you have any new pain, tenderness, sores, ulcers, or infections on your legs or feet. Your prescriber can suggest ways to treat these foot problems before they get worse.
Serious allergic reaction
- Risk factors: Allergy to metformin | Allergy to Jardiance (empagliflozin)
Some people can have a serious allergic reaction to Synjardy. Watch for signs like rash, swelling of your face or lips, swelling in your throat, or trouble breathing. Stop taking Synjardy and get medical care right away if this happens.
Let your prescriber know if you've had an allergic reaction to Jardiance (empagliflozin) or metformin before. You'll need to take a different medication to stay safe.
Low vitamin B12 levels
- Risk factors: Lower than average calcium or vitamin B12 intake | Problems with vitamin B12 or calcium absorption
Taking Synjardy can sometimes cause your vitamin B12 levels to drop. This might lead to vitamin B12 deficiency, which can put you at risk for anemia. It might be more likely to happen if you take this medication for several months or more.
Your prescriber might check your vitamin B12 levels and blood cell counts during treatment. Tell your care team if you feel very tired, dizzy, short of breath, or have tingling or numbness in your hands or feet. These could be signs of low vitamin B12 levels or anemia.
If your levels are too low, your prescriber might suggest vitamin B12 supplements to help. Your vitamin B12 levels also usually go back to normal after you stop taking Synjardy.
Synjardy dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5mg/500mg | 60 tablets | $0.00 | $0.00 |
| 12.5mg/500mg | 60 tablets | $0.00 | $0.00 |
| 12.5mg/1000mg | 60 tablets | $0.00 | $0.00 |
| 5mg/1000mg | 180 tablets | $0.00 | $0.00 |
Typical dosage for Synjardy
Your dose depends on whether you're switching to Synjardy from Jardiance (empagliflozin), metformin, both, or neither.
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- Adults and children 10 years and older: The recommended dose is 5 mg/500 mg (empagliflozin/metformin) or 5 mg/1,000 mg (empagliflozin/metformin) by mouth twice a day with food. The highest dose you can take is 12.5 mg/1,000 mg (empagliflozin / metformin) twice a day.
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- Adults only: The recommended dose is 10 mg/1,000 mg (empagliflozin/metformin) by mouth once a day in the morning with food. The highest dose you can take is 25 mg/1,000 mg (empagliflozin / metformin) once a day.
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How much does Synjardy cost?
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Synjardy contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Synjardy will not be safe for you to take.
- Severe kidney problems, including people on dialysis
- Metabolic acidosis (dangerously high levels of acid in the body), including diabetic ketoacidosis
- History of allergic reaction to Jardiance (empagliflozin) or metformin
What are alternatives to Synjardy?
