When your doctor tells you that you have Type 2 Diabetes, you may have been prescribed various medications to control your blood sugar levels. Among them, you may have received a pill that contains a combination of two drugs called Empagliflozin and Metformin. In Sri Lanka, this medicine can come under brand names like Synjardy XR. So today, let's talk about this medicine and the things to be careful about while using it, simply and clearly.
What really happens with this medicine?
Simply put, this is a medicine that lowers the level of sugar (glucose) in your blood. It is a combination of two types of medicine.
1. Empagliflozin: This works by making your kidneys excrete excess sugar from your body through your urine.
2. Metformin: This mainly reduces the amount of sugar produced by your liver, and also helps your body's cells respond better to insulin.
The most important thing is that this medicine is usually prescribed in conjunction with a good diet and exercise . Taking medicine alone is not enough, you definitely need to change your lifestyle.
Things you need to tell your doctor before starting medication
Before you start this medication, it is very important to tell your doctor about your complete health history, especially if you have any of the conditions listed below.
| Information type | Description |
|---|---|
| Pre-existing medical conditions | Kidney disease, liver disease, heart disease, high cholesterol, anemia (low blood count), low blood pressure, pancreas problems (Pancreatitis), Polycystic Ovary Syndrome (PCOS), Type 1 Diabetes. |
| Infections and other problems | If you have frequent urinary tract infections (UTIs), a history of yeast infections in the genital area, difficulty urinating, serious infections, or injuries. |
| Lifestyle and diet | If you drink alcohol frequently, follow a low-salt diet, eat less due to illness, surgery, or other reasons, are vomiting, or are dehydrated. |
| Special occasions | If you are pregnant or trying to get pregnant, a nursing mother, have an upcoming surgery, or have an allergy to any medicine or food. |
How to use the medicine correctly?
Remember these things well.
- Take this medicine with a glass of water.
- Swallow the pill whole. Do not break, crush, or chew it. This is because these are made for 'Extended-Release', meaning the medicine is released into the body over time. If you break the pill, the medicine can enter the body all at once and cause dangerous conditions.
- Take this medicine with a meal .
- Take the medicine exactly as prescribed by your doctor, at the prescribed time. Do not stop taking the medicine for any reason without your doctor's advice.
What to do if you take too much medicine?
If you think you have overdosed, immediately call the National Poisons Information Centre at the Colombo National Hospital (telephone number 0112686143) or go to the nearest hospital Emergency Treatment Unit (ETU) .
What if I miss a dose of medication?
If you miss a dose, take it as soon as you remember. But if it is almost time for your next dose, skip the missed dose and take your next dose as scheduled. Never take two doses at once.
Other medications that may interact with this medicine
It is very important to tell your doctor about all the medications you are taking (including vitamins, herbal remedies, and supplements). Some medications can cause problems when taken together.
In particular, some 'contrast' medicines that are injected into the body before tests such as X-ray, CT scan, and MRI should not be taken with this medicine. Also, do not take the medicine called Dofetilide.
Give your doctor a list of all the medications you take. That's the safest way to do it. Some over-the-counter cough and cold remedies may contain sugar and alcohol, which can affect your blood sugar levels.
Things you should be especially careful about when taking the medicine
- Lactic Acidosis: This is a rare but serious condition. If you experience nausea, vomiting, stomach pain, extreme tiredness, or difficulty breathing , stop taking the medicine immediately and call your doctor.
- Diabetic Ketoacidosis (DKA): This is another serious condition. If you experience symptoms such as dry mouth, excessive thirst, frequent urination, fruity breath odor, and difficulty breathing, seek medical attention immediately.
- HbA1C test: This blood test, which measures your blood sugar control over the past 2-3 months, should be done at the scheduled time as directed by your doctor.
- Measuring blood sugar levels: Learn the symptoms of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). Keep something to eat, such as a sugar cube or glucose tablet, in case your blood sugar drops.
- Surgery and tests: If you are going to have surgery, an MRI, or a CT scan, tell the medical team ahead of time that you are taking this medicine. You may need to stop taking the medicine before the procedure .
- Pregnancy: This medicine may increase your risk of getting pregnant. Therefore, talk to your doctor about using appropriate birth control. Tell your doctor right away if you become pregnant or think you may be pregnant.
- Vitamin deficiencies: Long-term use of this medication may cause low levels of vitamin B12 and folic acid. Therefore, talk to your doctor about eating a balanced diet and taking vitamin supplements if necessary.
What are the possible side effects?
Like any medicine, this one can have side effects. Let's break them down into two categories.
| If you experience these symptoms, tell your doctor immediately. | |
|---|---|
| Serious allergies | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Symptoms of Lactic Acidosis or DKA | Stomach ache, difficulty breathing, extreme fatigue, nausea, vomiting. |
| Infections | Urinary tract infection, frequent urination (UTI). Redness, swelling, itching, pain, and odor in or around the genital area. |
| Other serious symptoms | Signs of dehydration (dry mouth, excessive thirst, dark urine), signs of vitamin B12 deficiency (numbness in the hands and feet, dizziness, muscle weakness). |
| These are usually not serious, but if they persist, tell your doctor. | |
| Digestive system problems | Diarrhea, flatulence, nausea. |
| Other minor ailments | Headache , metallic taste in the mouth. |
How do you keep medicine safe?
- Keep out of reach of children and pets.
- Store at room temperature (between 15-30 degrees Celsius).
- Discard expired medication without using it.
Take-Home Message
- Always take this medicine exactly as prescribed by your doctor, in the correct dosage and at the correct time.
- Do not break, crush, or chew the tablet for any reason. Swallow it whole.
- Inform your doctor about all other medications, vitamins, and supplements you are taking.
- Be aware of the symptoms of serious side effects such as lactic acidosis, and seek medical advice immediately if you experience any of these.
- Check your blood sugar levels regularly and have your doctor perform tests, such as HbA1c, on time.
- If you have any concerns or doubts, please discuss them with your doctor.
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