SGLT2 inhibitor + biguanide
Empagliflozin with metformin
Brand names: Synjardy
Adult dose
Dose: 5/850mg or 5/1000mg or 12.5/850mg or 12.5/1000mg BD per titration
Route: Oral
Frequency: BD
Clinical pearls
- NICE NG28: SGLT2i preferred adjunct to metformin if established CV disease, HF, or CKD
- Sick-day rules for SGLT2i and metformin
- Withhold around contrast/surgery
Contraindications
- eGFR <30mL/min
- Acute illness with risk of dehydration
- Severe hepatic disease
- DKA history
- Pregnancy
- Hypersensitivity
Side effects
- GI upset (metformin)
- Genitourinary infections
- DKA
- Lactic acidosis (rare; metformin)
- Volume depletion
- Fournier's gangrene
Interactions
- Iodinated contrast (withhold metformin)
- Diuretics
- RAAS inhibitors
- Alcohol
Monitoring
- HbA1c
- eGFR
- B12 (long-term metformin)
- Volume status
- Foot care
Reference: BNF; NICE NG28; MHRA; ADA-EASD; https://bnf.nice.org.uk/drugs/empagliflozin-with-metformin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SCORE2-Diabetes 10-Year CVD Risk in Type 2 Diabetes · Cardiovascular Risk
- PCP-HF Risk Score (Pooled Cohort Equations to Prevent Heart Failure) · Heart Failure Prevention
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016