Iodinated Contrast Media
Severe
Database
Contrast-induced AKI + metformin accumulation
Withhold per protocol; check renal function
Source: Kimi deep-research + Cla
Drug reference
Empagliflozin + Metformin
Antidiabetic fixed-dose combination (SGLT2 inhibitor + biguanide) · Antidiabetic
Also known as Glyxambi, Jardiance Duo, Synjardy, Empaform M
START
5/500 mg or 12.5/500 mg PO twice daily with food
TYPICAL MAX
Empagliflozin 25 mg + metformin 2000 mg/day
STOP IF
Suspected DKA, eGFR <30, lactic acidosis features, or Fournier gangrene
WATCH
Renal function, ketones if unwell, genital/UTI symptoms, contrast-imaging timing
CDSCO approvedSchedule HATC A10BD20
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 2h · Tmax
- t½
- 12h · empag t½
- DURATION
- 12h · twice-daily
EXCRETION
Empagliflozin biliary/renal; metformin renal
route + CYP
INTERACTIONS
1 major
SEVERE in our sources
PREGNANCY
Insulin preferred in pregnancy; use only if clearly needed.
FDA category + note
Top interactionssee all 5 →
- Iodinated Contrast MediaSevereDatabaseKimi deep-research + Cla
Mechanism
Empagliflozin selectively inhibits SGLT2 in the proximal renal tubule (urinary glucose excretion); metformin reduces hepatic gluconeogenesis and improves insulin sensitivity (AMPK-mediated) — complementary mechanisms with proven CV/renal benefit.
Indications
Type 2 diabetes mellitus (when both components appropriate)
Dosing
- Adult
- 5 mg/500 mg or 12.5 mg/500 mg or 5 mg/1000 mg or 12.5 mg/1000 mg PO twice daily with meals; titrate metformin to tolerance, max empagliflozin 25 mg/day + metformin 2000 mg/day.
- Pediatric
- Not established for combination.
- Renal adjustment
- eGFR <45: do not initiate. eGFR <30: contraindicated.
- Hepatic adjustment
- Avoid metformin in significant hepatic impairment.
- Geriatric
- Assess renal function; conservative dosing.
- Max dose
- Empagliflozin 25 mg + metformin 2000 mg/day
Pharmacokinetics
Onset
Glucose lowering over days
Peak effect
Empagliflozin ~1.5 h; metformin ~2.5 h
Duration
~12 h (twice-daily)
Half-life
Empagliflozin ~12.4 h; metformin ~5–6 h
Bioavailability
Empagliflozin ~78%; metformin ~50–60%
Protein binding
Empagliflozin ~86%; metformin negligible
Metabolism
Empagliflozin UGT (minor); metformin not metabolised
Excretion
Empagliflozin biliary/renal; metformin predominantly renal
Contraindications
- eGFR <30 mL/min/1.73 m² (metformin lactic acidosis + SGLT2 inadequate efficacy)
- Acute metabolic acidosis / DKA
- Iodinated-contrast: temporarily withhold metformin
- Type 1 diabetes (relative — DKA risk)
- Severe hepatic impairment
- Acute conditions risking renal hypoperfusion / hypoxia
Side effects
Common
Genital mycotic infections (empagliflozin)Urinary tract infectionsGI upset / diarrhoea (metformin)Mild volume depletion / hypotensionHypoglycaemia (with insulin/sulfonylurea)
Serious
- Euglycaemic diabetic ketoacidosis (SGLT2 class)
- Necrotising fasciitis of perineum (Fournier gangrene, rare)
- Lactic acidosis (metformin)
- Severe hypovolaemia / AKI
- Lower-limb amputation (numerical signal — empagliflozin class data mixed)
Pregnancy & lactation
Pregnancy
Insulin preferred in pregnancy; use only if clearly needed.
Lactation
Limited combination data; individualise.
Drug interactions
Alcohol
Moderate
Database
Potentiated lactic acidosis + DKA risk
Avoid excess alcohol
Source: Kimi deep-research + Cla
Carbonic Anhydrase Inhibitors
Moderate
Database
Acidosis risk with metformin
Monitor; avoid if possible
Source: Kimi deep-research + Cla
Diuretics
Moderate
Database
Additive volume depletion
Monitor volume status; adjust diuretic
Source: Kimi deep-research + Cla
Sulfonylureas
Moderate
Database
Additive glucose lowering
Reduce SU/insulin dose
Source: Kimi deep-research + Cla
Related guidelines
Ask House about Empagliflozin + Metformin
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