Synjardy and Synjardy XR (empagliflozin/metformin)

Synjardy and Synjardy XR are brand-name prescription medications. They’re approved by the Food and Drug Administration (FDA) to treat type 2 diabetes.

Specifically, these medications are approved to manage blood sugar levels in people with type 2 diabetes. Doctors will prescribe Synjardy or Synjardy XR in combination with changes in diet and exercise.

In addition, Synjardy and Synjardy XR may help decrease the risk of death related to a cardiovascular problem. The drugs may have this effect in people with both type 2 diabetes and cardiovascular disease.

These drugs have a limitation of use. For details about this and the conditions mentioned above, see the “Synjardy and Synjardy XR: Uses” section below.

The following table provides key facts about Synjardy and Synjardy XR.

Synjardy tablets release their active drugs right after they’re taken. Unlike Synjardy, Synjardy XR tablets slowly release their active drugs into your body over time.

If you’re interested in taking this drug, search here to find a doctor who might prescribe it.

Synjardy and Synjardy XR each contain two active drugs: empagliflozin and metformin.

These medications only come as the brand-name medications Synjardy and Synjardy XR. They’re not currently available as generic medications.

A generic medication has an identical copy of the active drug or drugs found in a brand-name medication. Generics typically cost less than brand-name drugs.

As with most drugs, it’s possible to have side effects with Synjardy and Synjardy XR. These can include some mild side effects but also some serious ones.

To learn more about Synjardy and Synjardy XR’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Synjardy or Synjardy XR, you can do so through MedWatch.

Mild and serious side effects of Synjardy and Synjardy XR are listed in the table below. This table does not include all of Synjardy and Synjardy XR’s possible side effects.

* This is not a complete list of Synjardy and Synjardy XR’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the prescribing information for Synjardy and Synjardy XR.
† For more information about this side effect, see “Synjardy and Synjardy XR’s side effects explained” below.
‡ Synjardy and Synjardy XR have a boxed warning regarding the risk of lactic acidosis. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

Serious side effects from Synjardy and Synjardy XR aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Below, you can find detailed information about some of Synjardy and Synjardy XR’s side effects. To learn more about other side effects of this medication, talk with your doctor.  

It’s possible to develop lactic acidosis with Synjardy and Synjardy XR.

In fact, Synjardy and Synjardy XR have a boxed warning regarding this risk. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Lactic acidosis is a condition that occurs if there is too much acid in your blood. In rare cases, lactic acidosis can be serious or even life threatening. In studies of metformin (one of the active drugs in Synjardy and Synjardy XR), some people reported having lactic acidosis after taking the drug.

To learn more about how often this side effect occurred in clinical studies, see the prescribing information for Synjardy or Synjardy XR.

Due to this possible risk, it’s important to be aware of the symptoms of lactic acidosis while taking Synjardy or Synjardy XR. Symptoms to watch for include:

• sleepiness or weakness
• muscle pain
• nausea, vomiting, or diarrhea
• difficulty breathing
• abdominal pain
• feeling cold
• dizziness
• slow or irregular heartbeat

You may have an increased risk of lactic acidosis if you:

• have kidney or liver problems
• are also taking other medications that increase the risk of lactic acidosis
• drink alcohol often or in large amounts at one time
• are dehydrated
• have certain surgeries, X-rays, or other tests
• have congestive heart failure
• are age 65 years or older
• have a heart attack or stroke
• have a severe infection

What to do

If you experience symptoms of lactic acidosis, go to a hospital right away. It’s important that you receive treatment as soon as possible because lactic acidosis can be life threatening. Additionally, your doctor will recommend that you stop taking Synjardy or Synjardy XR. They’ll also recommend treatment for lactic acidosis.

In some cases, your doctor may recommend stopping Synjardy or Synjardy XR before you have surgery, certain X-rays, or other tests. This may be done to help prevent lactic acidosis from occurring.

Before starting Synjardy or Synjardy XR, your doctor may order blood tests to check how well your liver and kidneys are working. They may also ask questions about whether you have or have had certain health conditions and if you’re planning any surgeries or procedures. This way, your doctor can assess your risk for lactic acidosis. And they’ll recommend if Synjardy or Synjardy XR is safe for you to take.

For information about other conditions that may prevent your doctor from prescribing Synjardy or Synjardy XR, see the “Synjardy and Synjardy XR: Precautions” section below.

Talk with your doctor before starting Synjardy or Synjardy XR. They can advise if you have an increased risk of lactic acidosis with either drug. And they can recommend ways to help prevent this and other serious side effects.

Weight loss was reported in some people taking Synjardy or Synjardy XR during clinical studies.

To learn how often this side effect occurred in clinical studies, see the prescribing information for Synjardy or Synjardy XR.

It’s important to note that Synjardy and Synjardy XR aren’t approved to help with weight loss. If you’re interested in taking a medication to help you lose weight, talk with your doctor. They can recommend weight loss options that may be right for you.

What to do

If you notice weight loss that’s significant or unintentional with Synjardy or Synjardy XR, talk with your doctor. They can determine if Synjardy or Synjardy XR may be the cause of your weight loss. And they’ll recommend ways to help prevent further weight loss, if needed. 

Diarrhea was a common side effect of Synjardy and Synjardy XR in clinical studies. This is likely because diarrhea is a common side effect of metformin. And metformin is one of the active drugs in Synjardy and Synjardy XR.

To learn more about how often this side effect occurred in clinical studies, see the prescribing information for Synjardy or Synjardy XR.

Diarrhea may be worst when you first start taking either of these medications or your doctor increases your dosage. That said, it may improve after your body adjusts to Synjardy or Synjardy XR.

What to do

If you’re having diarrhea with Synjardy or Synjardy XR, tell your doctor. Especially let them know if it’s severe or bothersome. In some cases, diarrhea can be due to other, more serious side effects of these medications. These include infections and lactic acidosis.*

Your doctor can determine the cause of your diarrhea. And they’ll advise on the best way to manage it. They may recommend that you take another medication to help stop the diarrhea.

* Synjardy and Synjardy XR have a boxed warning regarding the risk of lactic acidosis. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous. See the “Risk of lactic acidosis” section above to learn more.

Below, you’ll find dosages that are commonly recommended for Synjardy and Synjardy XR. However, you should take the dosage your doctor prescribes for you. They’ll recommend the dosage that’s best for your needs.

Most often, doctors start by prescribing a low dosage of Synjardy or Synjardy XR. Then, they’ll change the dosage over time to an amount that’s right for the condition being treated. Doctors typically prescribe the smallest dosage that gives the desired outcome.

The dosage of Synjardy or Synjardy XR that your doctor prescribes will depend on factors such as:

• whether you’re taking Synjardy or Synjardy XR
• any health conditions you have
• the severity of the condition you’re taking either drug to treat
• your previous dose of metformin or empagliflozin (Jardiance), if you were taking either or both before switching to Synjardy or Synjardy XR

Synjardy and Synjardy XR are available as follows.

• Form: oral tablet
• Strengths of Synjardy:
  • 5 milligrams (mg) empagliflozin/500 mg metformin
  • 5 mg empagliflozin/1,000 mg metformin
  • 12.5 mg empagliflozin/500 mg metformin
  • 12.5 mg empagliflozin/1,000 mg metformin
• Strengths of Synjardy XR:
  • 5 mg empagliflozin/1,000 mg metformin
  • 10 mg empagliflozin/1,000 mg metformin
  • 12.5 mg empagliflozin/1,000 mg metformin
  • 25 mg empagliflozin/1,000 mg metformin

Synjardy tablets release their active drugs right after they’re taken. Unlike Synjardy, Synjardy XR tablets slowly release their active drugs into your body over time.

Recommended dosages for Synjardy and Synjardy XR in adults are described below.

Starting dosage for Synjardy:

• Your starting dosage will depend on how much metformin or empagliflozin you are taking before you switch to Synjardy. You’ll take your dose of Synjardy twice daily with meals. For example:
  • If you’re taking 500 mg of metformin twice daily, your doctor will likely recommend that you start by taking Synjardy 5 mg empagliflozin/500 mg metformin.
  • If you’re taking empagliflozin, you’ll start by taking a dose of Synjardy that contains about the same amount of empagliflozin you’re already taking.
  • If you’re taking both metformin and empagliflozin, your doctor will recommend the Synjardy tablet with the strength that’s closest to what you’re currently taking.

Starting dosage for Synjardy XR:

• Your starting dosage will depend on how much metformin or empagliflozin you are taking before you switch to Synjardy XR. You’ll take your dose of Synjardy XR once in the morning with a meal. For example:
  • If you’re taking 500 mg of metformin twice daily, your doctor will likely recommend that you start by taking Synjardy XR 5 mg empagliflozin/1,000 mg metformin.
  • If you’re taking empagliflozin, you’ll start by taking a dose of Synjardy XR that contains about the same amount of empagliflozin you’re already taking.
  • If you’re already taking both metformin and empagliflozin, your doctor will recommend the Synjardy XR tablet with the strength that’s closest to what you’re currently taking.

Maintenance dosage for Synjardy:

• Your doctor may slowly adjust your dosage of Synjardy until the drug is working for you. Maintenance dosages of Synjardy may vary from 5 mg empagliflozin/500 mg metformin twice daily to 12.5 mg empagliflozin/1,000 mg metformin twice daily.
• In any case, you’ll take your dose of Synjardy twice daily with meals.

Maintenance dosage of Synjardy XR:

• Your doctor may slowly adjust your dosage of Synjardy XR until the drug is working for you. Maintenance dosages of Synjardy XR may vary from 5 mg empagliflozin/1,000 mg metformin once daily to 25 mg empagliflozin/1,000 mg metformin once daily.
• In any case, you’ll take your dose of Synjardy XR once in the morning with a meal.

Maximum dosage for Synjardy and Synjardy XR:

• The maximum daily dosage for both Synjardy and Synjardy XR is 25 mg empagliflozin/2,000 mg of metformin.

Below are some things to consider about Synjardy and Synjardy XR’s dosage.

• Missing a dose. If you miss a dose of Synjardy or Synjardy XR, take the dose as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue with your usual dosing schedule. Never take two doses at once to try to make up for a missed dose. If you missed a dose of either drug and you’re unsure when to take your next dose, talk with your doctor or pharmacist. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
• Length of treatment. Doctors typically prescribe Synjardy or Synjardy XR as a long-term treatment. You’ll likely take either drug long term if you and your doctor feel it’s safe and effective for your condition.

Doctors may prescribe drugs other than Synjardy and Synjardy XR for your condition. Certain drugs may work better for you than others.

Synjardy and Synjardy XR are used to treat type 2 diabetes. Here’s a summary of other drugs that doctors sometimes prescribe for this condition.

To learn more about some alternatives to Synjardy and Synjardy XR, view the following articles:

• Synjardy vs. Invokamet
• Synjardy vs. Jardiance

Your doctor can tell you about other similar drugs, such as metformin, dapagliflozin/metformin (Xigdou XR), and canagliflozin (Invokana).

For further information about alternatives to Synjardy and Synjardy XR, ask your doctor. They can tell you about other medications that could be prescribed for your condition.

Like other medications, prices for Synjardy and Synjardy XR may vary. The drug’s price will depend on factors such as:

• the pharmacy you use
• your insurance coverage

The drugs’ costs with and without insurance will vary between people.

Here’s a list of things to consider when looking into the cost of Synjardy and Synjardy XR.

• Option for a 90-day supply. For some drugs, it’s possible to get a 90-day supply. If this option is approved by your insurance company, it can help lower the cost of the drug. It can also help you avoid frequent trips to your pharmacy. If you’d like to learn more about this option, ask your doctor, pharmacist, or insurance company.
• Need for prior authorization. Before insurance coverage for Synjardy or Synjardy XR is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Synjardy or Synjardy XR. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Synjardy or Synjardy XR, contact your insurance company.
• Possible cost assistance options. Financial assistance to help lower the cost of Synjardy and Synjardy XR is available. To learn more and see if you’re eligible for support, visit the manufacturer’s website. Also, check out this article to learn about ways to save on prescription drugs.
• Use of a mail-order pharmacy. Synjardy and Synjardy XR may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.
• Availability of a generic form. Synjardy and Synjardy XR don’t come in a generic form. A generic medication is an exact copy of the active drug or drugs in a brand-name medication. Typically, generics cost less than brand-name drugs.

Prescription drugs, such as Synjardy and Synjardy XR, are approved by the Food and Drug Administration (FDA) to treat certain conditions.

Synjardy and Synjardy XR are approved to manage blood sugar levels in people with type 2 diabetes. Doctors will prescribe Synjardy or Synjardy XR in combination with changes in diet and exercise.

With type 2 diabetes, your body can’t regulate blood sugar levels as well as usual. So, your blood sugar levels may be high or difficult to manage. This can lead to long-term complications, such as heart problems, kidney disease, or eye issues. Managing your blood sugar levels is important to help decrease your risk of other health conditions.

In addition to managing blood sugar levels, Synjardy and Synjardy XR may help decrease the risk of death related to a cardiovascular problem.

Empagliflozin can reduce this risk in adults with both type 2 diabetes and cardiovascular disease. And empagliflozin is one of the active drugs in Synjardy and Synjardy XR.

Having both type 2 diabetes and cardiovascular disease may increase the risk of cardiovascular death. This includes death caused by heart attack or stroke.

Synjardy and Synjardy XR have a limitation for their use. This means doctors may not prescribe them in certain situations.

These medications should not be used to treat type 1 diabetes. Synjardy and Synjardy XR may increase the risk of diabetic ketoacidosis (DKA) in people with type 1 diabetes. (DKA is a serious complication of diabetes.) If you have type 1 diabetes, your doctor will likely recommend a different treatment option for you.

Your doctor may recommend that you take Synjardy or Synjardy XR in combination with other medications to treat type 2 diabetes. It’s common to need multiple medications to manage blood sugar levels when treating type 2 diabetes.

For example, your doctor may recommend taking Synjardy or Synjardy XR with insulin, such as insulin aspart (NovoLog) or insulin detemir (Levemir).

Before you start taking Synjardy or Synjardy XR, talk with your doctor about the best diabetes treatment plan for you.

Synjardy and Synjardy XR are only approved for use in adults. It’s not known if Synjardy and Synjardy XR are safe or effective for children to take.

Talk with your child’s doctor about the best diabetes treatment plan if the child has diabetes.

A family doctor or endocrinologist may be able to prescribe Synjardy or Synjardy XR to you. If you don’t currently have a doctor, use this link to help find a healthcare professional.

To prepare for your visit, view the Healthgrades appointment guide for type 2 diabetes.

Synjardy and Synjardy XR are approved to treat type 2 diabetes. In addition, they can help decrease the risk of cardiovascular death in people with both type 2 diabetes and cardiovascular disease.

To learn more about these uses, see the “Synjardy and Synjardy XR: Uses” section above.

Diabetes occurs when the body has trouble regulating blood sugar levels. If your levels get too high, you may have long-term health complications. Managing your blood sugar levels is important to help decrease that risk.

In addition to managing blood sugar levels, Synjardy and Synjardy XR may help decrease the risk of death related to cardiovascular disease. The drugs may have this effect in people with both type 2 diabetes and cardiovascular disease.

Having both type 2 diabetes and cardiovascular disease can increase the risk of cardiovascular death. This includes death caused by heart attack or stroke.

Synjardy and Synjardy XR each contain two active drugs: empagliflozin and metformin.

Empagliflozin is a sodium-glucose co-transporter 2 (SGLT-2) blocker. It works by decreasing your body’s absorption of the sugar you consume. The medication helps your body excrete sugar in your urine instead of absorbing it into your bloodstream. 

Metformin is a biguanide. It works by lowering your blood sugar in these ways:

• It decreases the production of sugar by your liver.
• It decreases the absorption of sugar by your intestines.
• It helps your body use insulin better to move sugar out of your bloodstream.

Synjardy and Synjardy XR will begin working as soon as you take your first dose. However, it may take time before you notice a difference in your blood sugar levels.

Talk with your doctor about when you can expect to see your blood sugar levels affected by Synjardy or Synjardy XR.

Here are some common questions about Synjardy and Synjardy XR and brief answers to them. If you’d like to know more about these topics, ask your doctor.

No, pancreatitis (inflammation of the pancreas) hasn’t been reported as a side effect of Synjardy or Synjardy XR. However, be sure to tell your doctor if you’ve ever had pancreatitis.

If you’ve had pancreatitis or another pancreas condition, you may have an increased risk of diabetic ketoacidosis. This is a possible serious side effect of Synjardy and Synjardy XR.

With ketoacidosis, there is a high ketone level in your blood or urine. This can be very serious and sometimes life threatening. Tell your doctor if you have symptoms of ketoacidosis, which include:

• nausea or vomiting
• abdominal pain
• sleepiness
• difficulty breathing

Other medications used to treat type 2 diabetes, such as sitagliptin (Januvia), may increase the risk of pancreatitis.

Talk with your doctor about the best diabetes treatment plan for you. And let them know if you have additional questions about pancreatitis.

No, neither Synjardy nor Synjardy XR will cure your condition.

These medications work to manage blood sugar levels in people with type 2 diabetes. They may also help decrease the risk of cardiovascular death in people with both type 2 diabetes and cardiovascular disease.

Synjardy and Synjardy XR don’t cure these conditions. However, the drugs manage these conditions and lower the risk of serious effects occurring if the conditions aren’t treated.

It’s important to note that there is currently no cure for type 2 diabetes or cardiovascular disease related to type 2 diabetes. These conditions are best managed with a treatment plan recommended by your doctor.

No, insulin isn’t an ingredient in Synjardy or Synjardy XR. These drugs each contain two active drug ingredients: empagliflozin and metformin.

Empagliflozin and metformin work in different ways. However, like insulin, they help lower your blood sugar levels. To learn how these drugs work, see the “Synjardy and Synjardy XR: How they work” section above.

In some cases, your doctor may recommend that you take Synjardy or Synjardy XR in combination with insulin. Talk with your doctor about the best diabetes treatment plan for you.

Alcohol may interact with Synjardy and Synjardy XR.

You should try to avoid drinking a large amount of alcohol at once or drinking often while taking Synjardy or Synjardy XR.

Taking either of these drugs and drinking alcohol can increase your risk of side effects, which may sometimes be serious. For example, drinking alcohol during treatment with Synjardy or Synjardy XR can increase your risk of:

• nausea or vomiting
• headache
• diabetic ketoacidosis (a serious complication of diabetes)
• low blood sugar level
• lactic acidosis*

If you’re taking Synjardy or Synjardy XR and would like to drink alcohol, talk with your doctor. They can recommend how much alcohol, if any, is safe for you to consume.

* Synjardy and Synjardy XR have a boxed warning regarding the risk of lactic acidosis. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous. See “Risk of lactic acidosis” in the “Synjardy and Synjardy XR: Side effects” section above to learn more.

Synjardy and Synjardy XR may interact with other medications or certain supplements. They are not known to interact with foods.

Different interactions can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

If any of the interactions listed below might pertain to you, talk with your doctor. They can tell you what you need to do to avoid the interaction.

• Synjardy and Synjardy XR and other medications. Because Synjardy and Synjardy XR may interact with the following drugs, your doctor may recommend that you don’t take either medication with these drugs. Examples include:
  • carbonic anhydrase inhibitors such as topiramate (Topamax), zonisamide (Zonegran), acetazolamide, and dichlorphenamide (Keveyis)
  • the heart condition drug ranolazine (Ranexa)
  • the chemotherapy drug vandetanib (Caprelsa)
  • the HIV drug dolutegravir (Tivicay)
  • the antacid cimetidine (Tagamet)
  • loop diuretics such as furosemide (Lasix) and bumetanide (Bumex)
  • thiazide diuretics such as hydrochlorothiazide (Microzide) and chlorthalidone (Thalitone)
  • insulins such as insulin aspart (NovoLog), insulin detemir (Levemir), insulin glargine (Lantus, Toujeo), and insulin lispro (Humalog)
  • sulfonylureas such as glipizide (Glucotrol), glimepiride (Amaryl), glyburide (Diabeta)
• Synjardy and Synjardy XR and herbs and supplements. Certain herbs and supplements may interact with Synjardy and Synjardy XR. Examples include:
  • nicotinic acid (niacin, vitamin B3)
• Synjardy and Synjardy XR and foods. Synjardy and Synjardy XR are not known to interact with foods.
• Synjardy and Synjardy XR and lab tests. In some cases, medications can affect the results of certain lab tests. This is possible with Synjardy and Synjardy XR and the following tests:
  • urine glucose (sugar) test
  • 1,5-anhydroglucitol (1,5-AG) assay, which is a test used to evaluate blood sugar levels

Your doctor will recommend how you should take Synjardy or Synjardy XR. It’s important that you take either drug exactly as your doctor instructs.

Synjardy and Synjardy XR are oral tablets. You’ll take either drug by swallowing it.

Here’s a list of common questions related to taking Synjardy or Synjardy XR.

• When should I take Synjardy or Synjardy XR? This depends on which form your doctor prescribes. Either way, taking Synjardy or Synjardy XR doses at around the same time of day helps keep a steady level of the drug in your body. This helps the medication work effectively. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone. You’ll take your doses as follows:
  • If your doctor prescribes Synjardy, take your dose twice daily with a meal or snack.
  • If your doctor prescribes Synjardy XR, take your dose once daily in the morning with a meal or snack.
• Do I need to take Synjardy or Synjardy XR with food? Yes, you should take Synjardy or Synjardy XR with a meal or snack.
• Can Synjardy and Synjardy XR be chewed, split, or crushed? This depends on which form your doctor prescribes:
  • You should not chew, split, or crush Synjardy XR tablets. These tablets are made to slowly release their active drugs into your body throughout the day. If you crush, split, or chew the tablets, you could get too much medication at once, which may be dangerous.
  • The manufacturer of Synjardy does not specify if this form of the drug can be chewed, split, or crushed. If you are having difficulty swallowing the tablets, talk with your doctor or pharmacist to see if it may be safe to break the tablets. They may also be able to recommend a different medication for you.
• Is there a best time of day to take Synjardy and Synjardy XR? If you’re taking Synjardy, take your dose twice daily with food. If you’re taking Synjardy XR, take your dose once daily in the morning with food.

It’s not known whether it’s safe to take Synjardy or Synjardy XR during pregnancy.

However, in animal studies, empagliflozin caused kidney problems when given during the second or third trimester of pregnancy. And empagliflozin is one of the active drugs in Synjardy and Synjardy XR.

Animal studies do not always indicate what may happen in humans. However, due to this possible risk, taking Synjardy or Synjardy XR during the second or third trimesters of pregnancy is not recommended.

It’s important to note that unmanaged diabetes can also have negative effects on a developing fetus. So, you should talk with your doctor about other diabetes treatment options if you’re pregnant or planning to become pregnant. They can help determine the best diabetes treatment plan for you.

Doctors aren’t sure whether it’s safe to take Synjardy or Synjardy XR during pregnancy. Talk with your doctor about your birth control needs with Synjardy or Synjardy XR if you’re sexually active and you or your partner can become pregnant. Your doctor can recommend if you should use birth control with either medication.

If you’d like to learn more about taking Synjardy or Synjardy XR during pregnancy, view the information directly above.

Breastfeeding while taking Synjardy or Synjardy XR is not recommended. At this time, it’s unknown if these drugs have an effect on a breastfeeding child.

Synjardy and Synjardy XR each contain two active drug ingredients: empagliflozin and metformin.

Metformin is thought to pass into human breast milk. However, it’s not known what effect the drug may have on a breastfed child.

Empagliflozin passes into breast milk of animals. However, it’s not known if the drug passes into human breast milk or what effect it may have on a breastfed child. It’s possible that empagliflozin may affect kidney development, which occurs during pregnancy and for the first 2 years after birth. Due to this possible risk, breastfeeding while you’re taking Synjardy or Synjardy XR is not recommended.

This drug comes with several precautions.

This drug has a boxed warning, the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

It’s possible to develop lactic acidosis with Synjardy and Synjardy XR. Lactic acidosis is a condition that occurs if there is too much acid in your blood. In some cases, lactic acidosis can be serious or even life threatening. You should be aware of the symptoms of lactic acidosis, such as sleepiness, difficulty breathing, and abdominal pain. Tell your doctor right away if you have any of these symptoms.

You may have an increased risk of lactic acidosis if you have certain other health conditions, such as kidney problems. Your risk may also be raised if you take other medications that increase the risk of lactic acidosis.

Talk with your doctor about your other medications and other medical conditions before starting Synjardy or Synjardy XR. They can help you determine if you have an increased risk of lactic acidosis. They can also advise on how to help prevent this and other serious side effects from occurring.

To learn more, see the “Synjardy and Synjardy XR: Side effects” section above.

Tell your doctor about your health history before starting treatment with Synjardy or Synjardy XR. Your doctor may not recommend either medication if you have certain factors affecting your health or specific medical conditions.

These factors and conditions include those listed below.

• Kidney problems. Synjardy and Synjardy XR can increase the risk of kidney problems. If you already have kidney problems, taking either medication may make your condition worse. Talk with your doctor to see if it’s safe for you to take Synjardy or Synjardy XR.
• Liver problems. It’s possible for Synjardy and Synjardy XR to increase the risk of liver problems. If you already have liver problems, taking either medication may make your condition worse. Your doctor can recommend if it’s safe for you to take Synjardy or Synjardy XR.
• Ketoacidosis. Synjardy and Synjardy XR can increase the risk of diabetic ketoacidosis. This condition occurs when your body has a high ketone level. Ketoacidosis can be life threatening. If you’ve had ketoacidosis, tell your doctor before starting Synjardy or Synjardy XR. They may recommend monitoring you more often than usual for symptoms of ketoacidosis. If you’re currently having ketoacidosis, your doctor will likely recommend that you take a medication other than Synjardy or Synjardy XR.
• Heart problems, such as congestive heart failure. You may have an increased risk of lactic acidosis if you have certain heart problems and take Synjardy or Synjardy XR. These medications have a boxed warning for the risk of lactic acidosis. (See “FDA warning: Risk of lactic acidosis” directly above to learn more.) Your doctor may monitor you more often than usual during treatment with Synjardy or Synjardy XR if you have certain heart problems.
• Past infections of the vagina or penis. If you’ve had yeast infections or infections of the vagina or penis, tell your doctor before starting Synjardy or Synjardy XR. These medications may increase the risk of infections of the vagina and penis. If you have a history of these infections, you may have an increased risk of developing them with Synjardy or Synjardy XR. Your doctor may recommend monitoring you more often for symptoms of these infections while you’re taking Synjardy or Synjardy XR.
• Urinary tract infections (UTIs) or problems urinating. Tell your doctor if you have frequent UTIs, problems urinating, or UTIs that keep coming back. Synjardy and Synjardy XR can increase the risk of UTIs. In some cases, these infections can be serious or even life threatening. Your doctor may monitor you more often than usual for symptoms of a UTI if you take Synjardy or Synjardy XR.
• Upcoming surgery. If you have to stop eating or drinking before having surgery, your doctor may have you temporarily stop taking Synjardy or Synjardy XR. This is because these drugs can increase the risk of kidney problems if you aren’t eating or drinking like usual. Talk with your doctor to determine if you should stop taking Synjardy or Synjardy XR before an upcoming surgery.
• Upcoming X-ray or other imaging procedure. Certain dyes used in medical imaging tests can interact with Synjardy and Synjardy XR. This can increase the risk of kidney problems. Due to this risk, your doctor may recommend that you temporarily stop taking Synjardy or Synjardy XR before an X-ray or other imaging procedure.
• Pancreas problems, such as pancreatitis. If you’ve had pancreas problems or pancreatitis, you may have an increased risk of lactic acidosis with Synjardy or Synjardy XR. These medications have a boxed warning for the risk of lactic acidosis. (See “FDA warning: Risk of lactic acidosis” directly above to learn more.) Your doctor may recommend monitoring you more often than usual if you take either medication. Or your doctor may advise that you take a different treatment.
• Frequently consuming alcohol or drinking excessive amounts of alcohol. You may have an increased risk of lactic acidosis if you drink alcohol often or excessively. These medications have a boxed warning for the risk of lactic acidosis. (See “FDA warning: Risk of lactic acidosis” directly above to learn more.) Your doctor may recommend avoiding alcohol or limiting alcohol intake while you’re taking Synjardy or Synjardy XR.
• Low level of vitamin B12. Metformin (one of the active drugs in Synjardy and Synjardy XR) may cause low vitamin B12 levels. If you already have a low vitamin B12 level, taking Synjardy or Synjardy XR may worsen it. Talk with your doctor to see if it’s safe for you to take Synjardy or Synjardy XR.
• Type 1 diabetes. Synjardy and Synjardy XR may increase the risk of diabetic ketoacidosis in people with type 1 diabetes. Due to this risk, your doctor likely won’t prescribe Synjardy or Synjardy XR to treat type 1 diabetes.
• Older adults. You may have an increased risk of lactic acidosis if you’re age 65 years or older. These medications have a boxed warning for the risk of lactic acidosis. (See “FDA warning: Risk of lactic acidosis” directly above to learn more.) Due to this risk, your doctor may monitor you more often than usual if you’re in this age group and are taking Synjardy or Synjardy XR.
• Irregular periods or absence of periods before menopause. Synjardy and Synjardy XR contain the drug metformin. When people with a history of irregular periods take metformin, it may cause ovulation. (Ovulation is when an egg is released from your ovary.) If the egg is fertilized by a sperm, pregnancy can occur. So, these medications may increase the likelihood of pregnancy if you’re sexually active. These medications may not be safe to take while pregnant. For details, see “Synjardy and Synjardy XR: Taking while pregnant” above.
• Allergic reaction. Your doctor will likely not prescribeSynjardy and Synjardy XR if you’ve had an allergic reaction to them or any of their ingredients. To find out about other treatment options, talk with your doctor.
• Pregnancy. It’s possible that Synjardy or Synjardy XR may cause harm to a developing fetus. If you’d like to learn more about taking Synjardy or Synjardy XR while pregnant, view the “Synjardy and Synjardy XR: Taking while pregnant” section above.
• Breastfeeding. Synjardy and Synjardy XR may be present in breast milk, and they may affect a breastfeeding child. If you’d like to learn more about taking Synjardy or Synjardy XR while breastfeeding, view the “Synjardy and Synjardy XR: Taking while breastfeeding” section above.

To learn more about effects of Synjardy and Synjardy XR that could be harmful, see the “Synjardy and Synjardy XR: Side effects” section above.

Serious effects can occur if you take more than the recommended dosage of Synjardy or Synjardy XR. Do not take more Synjardy or Synjardy XR than your doctor recommends.  

Overdose can lead to lactic acidosis.* Possible symptoms of lactic acidosis could include:

• sleepiness or weakness
• muscle pain
• nausea, vomiting, or diarrhea
• difficulty breathing
• abdominal pain
• feeling cold
• dizziness
• slow or irregular heartbeat

* Synjardy and Synjardy XR have a boxed warning regarding the risk of lactic acidosis. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous. See “Risk of lactic acidosis” in the “Synjardy and Synjardy XR: Side effects” section above to learn more.

Call your doctor if you think you’ve taken too much Synjardy or Synjardy XR. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number. Or go to the nearest emergency room right away.

Here’s some information about Synjardy and Synjardy XR’s expiration date, as well as how to store and dispose of these drugs.

• Expiration. Your pharmacist will add an expiration date to the label on Synjardy or Synjardy XR’s bottle. This date is usually 1 year from the date the medication was dispensed to you. Expiration dates help ensure that a medication is effective during a period of time. The Food and Drug Administration (FDA) advises that you avoid using expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.
• Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug. Synjardy and Synjardy XR tablets should be stored at room temperature, between 68°F and 77°F (20°C and 25°C ). If needed, you can store the medications between 59°F and 86°F (15°C and 30°C).
• Disposal. It’s important to safely dispose of Synjardy or Synjardy XR if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment. Ask your pharmacist for information about disposing of Synjardy or Synjardy XR. Also, check out this page for several tips on safe medication disposal.

If you have questions about Synjardy and Synjardy XR, talk with your doctor. They can advise whether Synjardy or Synjardy XR could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

• How can I treat side effects that I experience with Synjardy or Synjardy XR?
• Is Synjardy or Synjardy XR a better treatment option for me?
• What should I do if I become pregnant while I’m taking Synjardy or Synjardy XR?
• If Synjardy or Synjardy XR isn’t working well enough, can my dosage be changed?

Your doctor may also tell you about other treatment options for your condition. You may find this article helpful in learning about alternative drugs for diabetes. And check out our selection of videos on diabetes and cardiovascular conditions.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.