Medication Information Leaflet

What is this medication for?

Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. SGLT2 inhibitors work by preventing the kidneys from reabsorbing sugar (glucose) back into the blood, and this increases the amount of sugar that is removed in the urine. It is used in the treatment of diabetes. It works together with lifestyle changes, such as having a healthy diet and regular exercise, to reduce blood sugar levels.

If you suffer from heart failure, this medication can also be given to you to help with your heart condition, even if you do not have diabetes.

How should I take or use this medication?

Follow the instructions on your medication label and take the medication as prescribed by your doctor. It is usually taken once a day. You may take this medication before food or after food.

What should I do if I forget to take or use this medication?

If you missed a dose, take the missed dose as soon as you remember. Then take your next dose at the usual time.

If it is less than 12 hours until your next dose, skip the missed dose and take your next dose at the usual time.

Do not double your dose or use extra medication to make up for the missed dose.

What precautions should I take when taking or using this medication?

Inform your healthcare professional if you:

• Are allergic to this medication or any of the other ingredients of this medication
• Have Type 1 diabetes mellitus (as this medication is not recommended for Type 1 diabetes mellitus)
• Are pregnant, planning to become pregnant or breastfeeding
• Have heart or kidney problems
• Have any foot ulcers/ infections
• Drink alcohol often
• Suffered from diabetic ketoacidosis in the past. This is a complication of diabetes that is caused by an increase in the amount of ketones in your blood or urine, which causes your blood to become more acidic.
• Have a history of urinary tract infections or bladder cancer
• Plan to go for any surgery or procedure (you may need to stop the medication temporarily at least 72 hours before that)

If you need to do fasting blood tests, do not take your medication until your blood has been taken and you have eaten.

What are some common side effects of this medication?

Like all medications, this medication may cause some possible side effects but not everyone experiences them. Consult your healthcare professional if any of the side effects becomes severe and bothersome.

The common side effects of Empagliflozin include:

• Genital infections

  This medication may increase the chances of getting a genital infection of the vagina or penis. Symptoms include itch or unusual discharge from the genitals.

  • To minimise the chances of this happening, always practise good genital hygiene

• Urinary tract infection

  This medication may increase the chances of getting a urinary tract infection. Symptoms include a burning feeling when you pass urine, the need to pass urine more often, feeling like you need to pass urine more often, or if you see blood in your urine.

  • To minimise the chances of this happening, always practise good genital hygiene

• Low blood pressure

  You may feel giddy or light-headed, especially when you get up from a lying or sitting position. This is more likely to happen in the morning or when you first get out of bed.

  • Getting up slowly may help but if the problem continues, check with your doctor.

• Dehydration (not having enough water in the body)

  You may experience dehydration as it removes the excess sugar in your body through your urine.

  • You should take an extra 1 to 2 glasses of water every day unless your doctor tells you to control your liquid intake.

• Low blood sugar

  Low blood sugar can happen and the chances of this happening are increased when you take this medication with other medications used in diabetes. Please inform your doctor if low blood sugar level occurs as your doctor may need to adjust your diabetes medications.

Symptoms of low blood sugar include

• Weakness
• Dizziness
• Hunger
• Sweating
• Trembling
• Blurred vision
• Walking unsteadily
• Fast heartbeat

If you experience any of these low blood sugar symptoms, do the following immediately:

Step 1: Check your blood sugar level with a home blood sugar meter (glucometer) if available. If your blood sugar level is less than 4 mmol/L, take 15 grams of fast-acting sugar. Examples of 15 grams of fast-acting sugar include:

• 3 glucose tablets or
• Half a glass of fruit juice (200ml) or
• Half a can of soft drink or sweetened drink (175ml) or
• 1 can of less sugar soft drink (330ml) or
• 3 teaspoons of sugar, honey or syrup

Step 2: Monitor yourself for 15 minutes. If you have a glucometer (home blood sugar meter), check your blood sugar level again after 15 minutes.

Step 3: If your blood sugar level is still less than 4 mmol/L or you still have symptoms of low blood sugar, you should take another 15 grams of fast-acting sugar as per Step 1.

If your symptoms do not go away, see a doctor or go to the hospital immediately.

Step 4: Take your meal or snack if your blood sugar level is 4 mmol/L and above after consuming the fast-acting sugar earlier on.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

If the following serious side effects happen, you should consult your healthcare professional immediately:

• Diabetic ketoacidosis (DKA)
  • DKA is a rare and serious side effect associated with this medication.
  • Symptoms include:
    • Pain in the stomach or abdominal area
    • Nausea or vomiting that does not go away
    • Feeling confused, tired or unusually sleepy
    • Difficulty breathing (shortness of breath)
    • Feeling very thirsty and sweet fruity smell in your breath
  • To lower the chances of DKA, make sure to drink enough water every day. Extended periods of fasting or large reductions in food intake may also increase the chances of DKA happening.
• Fournier’s gangrene
  • This medication is also very rarely associated with a serious bacterial infection in the genital or perineal area.
  • You should stop the medication and seek medical attention immediately if you:
    • Develop a fever above 38 °C
    • Develop pain, redness or swelling in your genitals or in the area between your genitals and anus
  • To minimise the chances of this happening, always practise good genital hygiene
• Ulcers or signs of infections on your feet (eg. pain or tenderness, redness, swollen appearance, feeling of warmth)

What food or medication should I avoid when I take or use this medication?

Avoid taking alcohol with this medication as it may cause symptoms such as flushing, nausea, vomiting, headache, fast heartbeat, fast breathing, and giddiness.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How do I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing it into the rubbish chute or bin.

What else should I know about this medication?

When to temporarily stop Empagliflozin?

• When feeling unwell eg. high fever, loss of appetite, diarrhoea, vomiting or at risk of dehydration
• If you are pregnant

Ask your doctor if you need to stop this medication or take extra precautions, if you are planning for the following:

• Surgical or dental procedure
• A weight loss diet plan involving very low carbohydrate intake such as the ketogenic diet
• Endurance physical activities such as running a marathon
• Pregnancy
• Fasting during Ramadan

You are encouraged to check your blood sugar levels with a glucometer (blood sugar meter) as instructed by your healthcare professional.

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Disclaimer

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup, and supported by the Ministry of Health. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Please visit www.moh.gov.sg/knowyourmeds and www.ndf.gov.sg for more information on medication.

Last updated on May 2023