Empagliflozin + Metformin Hydrochloride

Empagliflozin + Metformin Hydrochloride is a antidiabetic combination (sglt2 inhibitor + biguanide) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Type 2 diabetes mellitus in adults, with diet and exercise, when metformin alone is not enough
• Patients already taking empagliflozin and metformin separately — for convenience
• Type 2 diabetic patients with heart disease, heart failure or chronic kidney disease — empagliflozin reduces cardiovascular and kidney risks (doctor's assessment)

Not for type 1 diabetes or diabetic ketoacidosis.

Your doctor will choose the strength of Empagliflozin + Metformin Hydrochloride based on your current treatment, kidney function and sugar levels.

• Take with meals, usually twice daily, to reduce metformin's stomach effects.
• Drink adequate water through the day — the medicine increases urination.
• If you miss a dose, take it with the next meal that day; never double up.
• Sick days and fasting: if you cannot eat or drink, have severe vomiting/diarrhoea, or plan prolonged fasting (including before surgery), ask your doctor — this medicine is usually paused temporarily to avoid dehydration and ketoacidosis.

Diabetes is a lifelong condition. Never stop Empagliflozin + Metformin Hydrochloride on your own because readings look normal — they are normal because the medicine is working, and the heart-kidney protection also stops the day you stop the tablet.

Possible side effects include:

• Genital fungal infections (itching, discharge) in women and men — the most common effect of sugar in the urine
• Urinary tract infections; increased urination and thirst
• Dehydration, dizziness or low pressure, especially in the elderly or with diuretics
• Nausea, loose stools, metallic taste (metformin, usually temporary)
• Low blood sugar mainly when combined with insulin/sulfonylureas
• Rare but serious: diabetic ketoacidosis (DKA) even with near-normal sugar — nausea, vomiting, stomach pain, deep fast breathing, fruity breath; emergency
• Very rare: lactic acidosis (metformin); a severe infection of the genital area (Fournier's gangrene) — severe pain, swelling, fever needs urgent care

• Genital hygiene is essential: wash and dry the genital area daily and after urination — sugar in the urine encourages fungal growth. Report persistent itching or discharge.
• Avoid dehydration: drink enough water, especially in hot weather, fever, vomiting or diarrhoea; dizziness on standing may signal fluid loss.
• DKA warning: nausea, vomiting, abdominal pain or unusual tiredness needs urgent review even if sugar is not very high.
• Hold the medicine when fasting or seriously ill, per your doctor — including prolonged religious fasting and before planned surgery (usually stopped 3 days before).
• Kidney function will be tested before starting and periodically.
• Tell your doctor before contrast-dye scans (metformin pause).
• Limit alcohol; elderly patients need closer monitoring.

• Insulin and sulfonylureas: higher hypoglycaemia risk — doses may need reduction
• Diuretics (furosemide, hydrochlorothiazide): added fluid loss — dehydration and low pressure risk
• Blood pressure medicines: pressure may fall further; monitor
• Iodinated contrast dye: pause metformin as directed
• Alcohol: raises lactic acidosis and DKA risk
• Corticosteroids and some other drugs: raise sugar — control needs review
• Empagliflozin makes urine glucose tests uninterpretable — doctors use blood tests instead

• Allergy to empagliflozin, metformin or any component
• Severe kidney impairment (per current eGFR limits), dialysis
• Diabetic ketoacidosis, now or in the past on this drug class without doctor approval
• Metabolic acidosis
• Severe dehydration, shock, severe infection
• Conditions with low tissue oxygen — recent heart attack, severe heart or respiratory failure
• Severe liver disease or alcohol abuse
• Type 1 diabetes

Pregnancy: Not recommended. Empagliflozin may affect the developing baby's kidneys, particularly from the second trimester. Pregnant women with diabetes are normally switched to insulin under specialist care. Inform your doctor immediately if you are or plan to become pregnant.

Lactation: Avoid while breastfeeding — empagliflozin may pass into milk and could affect the infant's developing kidneys; metformin appears in milk in small amounts. Your doctor will select a safer regimen.

Store below 30°C in a dry place, protected from light and moisture. Keep in the original pack and out of the reach of children. Do not use after the expiry date.