Answers to common questions about empagliflozin

Starting a new medicine can be worrying, but knowing what to expect and being prepared can help. Here are the answers to some common questions people ask about empagliflozin.

On this page, you can find the following information:

What are the benefits of taking empagliflozin?

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.

How does empagliflozin lower blood glucose?

Empagliflozin works by increasing the amount of glucose that leaves your body in your pee. As a result, the levels of glucose in your blood are reduced. Read more about type 2 diabetes.

If I take empagliflozin, can I stop my diet and exercise?

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. 

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 ketoacidosisIf 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. 

How much empagliflozin should I take?

In 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.

Empagliflozin is also available as a combined tablet with metformin, called Jardiamet. The usual dose of Jardiamet is 1 tablet 2 times a day. In New Zealand Jardiamet tablets are available in 4 strengths:

  • Jardiamet 5 mg/500 mg
  • Jardiamet 5 mg/1,000 mg
  • Jardiamet 12.5 mg/500 mg
  • Jardiamet 12.5 mg/1,000 mg

Should I take empagliflozin with food?

You can take empagliflozin with or without food. Take empagliflozin once a day, at about the same time each day. Any time of the day is fine, although some people prefer the mornings, because empagliflozin may cause you to pee more, which may affect your sleep if you take it in the evening. 

If you are taking Jardiamet, take 1 tablet 2 times a day, in the morning and the evening. Jardiamet is best taken with or just after food, or a meal, to lessen the chance of stomach upset.

Can I drink alcohol while taking empagliflozin?

It is best to limit or avoid drinking excessive amounts of alcohol while you are taking empagliflozin. 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

Does empagliflozin cause weight gain? 

No, empagliflozin does not cause weight gain and usually helps you lose weight. 

Will changes to my diet affect empagliflozin?

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.

How long will I need to take empagliflozin for?

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.

Do I have to pay for empagliflozin?

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. 

Will I need to test my blood glucose with a glucometer while I’m taking empagliflozin?

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.

Should I stop taking empagliflozin if I am unwell?

If you are unwell, you should stop your empagliflozin until you are well again. 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. High ketone levels can cause a serious but rare side effect called ketoacidosis. Talk to your healthcare team about when to start your empagliflozin again.

Can I take empagliflozin before an operation or a procedure?

You will need to stop your empagliflozin before an operation or procedure. Discuss with your healthcare team when to stop and restart your empagliflozin. The following is a guide:

  • If you are going to have bowel surgery or a procedure that requires bowel preparation, such as colonoscopy, sigmoidoscopy or capsule endoscopy, stop your empagliflozin at least 4 days before (3 days before the procedure and on the day of the procedure).
  • If you are going to have other surgery, stop your empagliflozin at least 3 days before (2 days before the operation and on the day of the operation).

Can I take empagliflozin if I am 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.

Can I take empagliflozin if I am 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.

What should I do if I forget to take empagliflozin?

If you forget to take your dose, take it as soon as you remember, unless it is less than 12 hours until your next dose. If that’s the case, take your next dose at the usual time and skip the forgotten dose.

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.

Does empagliflozin cause serious side effects?

Empagliflozin can cause side effects, although not everyone gets them. 

Common side effects

These are usually mild and go away with time. Talk to your healthcare team if these side effects cause you problems or don’t go away:

  • peeing more often than usual
  • pain or burning feeling when you pee
  • mild skin rash or itchy skin.

Rare, serious side effects

Tell your healthcare team or Healthline 0800 611 116 immediately if you notice these side effects and tell them you are taking empagliflozin:
  • being sick (vomiting)
  • feeling very thirsty (dehydrated)
  • being confused or unusually tired
  • stomach pain
  • sweet-smelling breath
  • deep or fast breathing
  • fever (high temperature)
  • severe swelling, pain or redness in your anus (bottom) and genitals (vagina and penis)
  • feeling weak, faint, dizzy
  • feeling irritable
  • headache
  • tremor (shakes)
  • blurred vision.

Can empagliflozin cause thrush?

Yes, empagliflozin can increase your risk of thrush. Empagliflozin causes you to pee more and have more glucose in your pee. This puts you at risk of getting thrush or groin infections.

Washing your genitals helps prevent this. Women should wash their groin and vulval area at least 2 times a day and men should wash their penis, foreskin and groin area at least once a day.

If you have symptoms of thrush, tell your healthcare provider. They can prescribe treatment for it.

How will I know my empagliflozin is working?

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.

What if empagliflozin is not working?

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.

Reference

  1. Empagliflozin and dulaglutide – your questions answered He Ako Hiringa, NZ
Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr Ryan Paul, Endocrinologist, Hamilton Last reviewed: 31 Aug 2021