empagliflozin/metformin

Action and Spectrum

Actions and Spectrum:

empagliflozin/metformin is a combination medication used to treat type 2 diabetes. It contains two active ingredients: empagliflozin and metformin. Let’s discuss the actions and spectrum of this medication:

• empagliflozin: It belongs to a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Empagliflozin works by inhibiting the SGLT2 protein in the kidneys, which reduces the reabsorption of glucose and increases the excretion of glucose through urine. This mechanism helps lower blood glucose levels and leads to a modest amount of weight loss.
• metformin: It is a medication from the biguanide class and is considered the first-line treatment for type 2 diabetes. Metformin works by reducing the amount of glucose produced by the liver and improving the body’s response to insulin. It also increases the uptake and utilization of glucose by peripheral tissues such as muscles, which helps lower blood glucose levels.

Drug Interaction

Adverse Reaction

Frequency defined:  

>10% 

Urinary tract infection 

1-10% 

Nasopharyngitis 

Hypoglycemia 

Upper respiratory tract infections 

Increased hematocrit 

Increased LDL cholesterol 

Post-marketing reports 

Ketoacidosis 

Fournier gangrene 

Severe arthralgia 

Skin rashes 

Rhabdomyolysis 

Constipation 

Acute pancreatitis 

Urosepsis 

Anaphylaxis 

Exfoliative skin conditions 

Angioedema 

Bullous pemphigoid 

Mouth ulceration 

Acute kidney injury 

Black Box Warning

Black Box Warning:

None

Contraindication / Caution

Contraindication / Caution:

Pregnancy / Lactation

Pregnancy consideration: Not recommended during the second and third trimesters as is causes adverse renal effects 

Lactation: Excretion of the drug in human breast milk is unknown  

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology:

Combining empagliflozin and metformin provides complementary mechanisms of action to improve glycemic control, reduce insulin resistance, promote weight loss, and potentially confer cardiovascular benefits. The combination is often used when single-agent therapy does not adequately control blood glucose levels in patients with type 2 diabetes.

Pharmacodynamics:

empagliflozin:

• Mechanism of Action: empagliflozin is a selective inhibitor of sodium-glucose co-transporter 2 (SGLT2), primarily expressed in the proximal renal tubules. It works by inhibiting the reabsorption of glucose in the kidneys, leading to increased urinary glucose excretion and lowering blood glucose levels.
• Effects on Glucose Control: By inhibiting renal glucose reabsorption, empagliflozin reduces plasma glucose levels and contributes to the improvement of glycemic control in patients with type 2 diabetes.
• Additional Effects: empagliflozin has been shown to promote weight loss, reduce blood pressure, and have cardiovascular benefits in patients with diabetes. These effects may be attributed to its diuretic action, leading to reduced fluid volume and a decrease in body weight.

metformin:

• Mechanism of Action: metformin is classified as a biguanide antidiabetic agent. Its primary mechanism of action involves reducing hepatic glucose production and enhancing insulin sensitivity in peripheral tissues, such as skeletal muscle. It does not stimulate insulin release from the pancreas.
• Effects on Glucose Control: metformin improves glucose control by reducing basal and postprandial blood glucose levels. It decreases hepatic gluconeogenesis (glucose production), increases peripheral glucose uptake, and improves insulin action.
• Additional Effects: metformin may have beneficial effects on lipid metabolism, reducing triglyceride levels and improving lipid profiles. It has also been associated with modest weight loss and a lower risk of cardiovascular events in patients with diabetes.

Adminstartion

Patient Information Leaflet

Patient information leaflet

Generic Name: empagliflozin/metformin

Why do we use empagliflozin/metformin?

empagliflozin/metformin is used in the treatment of type 2 diabetes mellitus.  Each component works in a different way to help manage blood sugar levels and improve glycemic control. empagliflozin helps lower blood sugar levels, leading to improved glycemic control. It also promotes weight loss and may have beneficial effects on blood pressure and cardiovascular outcomes. metformin works primarily by reducing the production of glucose in the liver and improving the body’s sensitivity to insulin, thus enhancing glucose utilization by cells.