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Synjardy
Empagliflozin / Metformin
$288.00
5mg / 850mg · 3 × 60 tablets · 3 months supply
BrandBranded medicine· By Boehringer
$96.00 per month
Strength
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Annual cost
$1152a year at this pack size
Prescription required
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5mg / 850mg
5mg / 1000mg
12.5mg / 500mg
12.5mg / 850mg
12.5mg / 1000mg
FDA boxed warningLactic acidosis
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic impairment, and mitochondrial diseases.
Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the full prescribing information.
If metformin-associated lactic acidosis is suspected, immediately discontinue SYNJARDY or SYNJARDY XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.
If lactic acidosis is suspected, discontinue SYNJARDY or SYNJARDY XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.
About Synjardy
Overview
Synjardy tablets contain empagliflozin and metformin hydrochloride. They are used alongside diet and exercise to improve blood sugar control in adults and children aged 10 years and older with type 2 diabetes. The two ingredients combine different types of diabetes medicine, an SGLT2 inhibitor and a biguanide, to help control blood sugar.
What it treats
- Improving blood sugar control alongside diet and exercise in adults and children aged 10 years and older with type 2 diabetes. - In adults with type 2 diabetes, the empagliflozin component is also indicated to reduce the risk of: - Cardiovascular death in those with established cardiovascular disease. - Cardiovascular death and hospitalisation for heart failure in those with heart failure. - Sustained decline in kidney function, end-stage kidney disease, cardiovascular death and hospitalisation in those with chronic kidney disease at risk of progression.
Safety information
Side effects
Common side effects include urinary tract infections, genital yeast infections in women, diarrhoea, nausea, vomiting, gas, abdominal discomfort, indigestion, weakness and headache. Serious side effects include lactic acidosis (a build-up of lactic acid in the blood), ketoacidosis, loss of body fluid, low blood sugar, serious allergic reactions, and severe urinary or genital infections. Ketoacidosis can occur regardless of blood sugar level. Contact a doctor promptly if any of these are suspected. Seek immediate medical attention for pain, tenderness, redness or swelling around the genitals or the area between the genitals and anus, together with fever or feeling unwell. These may be signs of Fournier’s gangrene, a serious tissue infection. Severe urinary infections may include kidney infection or infection spreading into the bloodstream. Low blood sugar risk is higher in adults taking insulin or medicines that stimulate insulin release. In children aged 10 years and older, the risk was higher regardless of insulin use. Lower-limb amputation is also a serious risk listed in the label. Contact a doctor promptly about infections or ulcers on the legs or feet. Metformin may lower vitamin B12 levels; regular blood tests are needed to check for this.
FDA boxed warning
Lactic acidosis
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic impairment, and mitochondrial diseases.
Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the full prescribing information.
If metformin-associated lactic acidosis is suspected, immediately discontinue SYNJARDY or SYNJARDY XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.
If lactic acidosis is suspected, discontinue SYNJARDY or SYNJARDY XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.
A boxed warning is the strongest warning the US Food and Drug Administration requires on a medicine label. Text is taken from the official label, with internal section references removed.
When to call your doctor
If symptoms are severe or getting worse quickly, seek emergency care rather than waiting.
Before taking this medicine
Do not take Synjardy if you have severe kidney impairment (eGFR below 30 mL/min/1.73 m²), acute or chronic metabolic acidosis, including diabetic ketoacidosis, or an allergy to empagliflozin, metformin hydrochloride or any other ingredient. Avoid use if you have liver impairment. Synjardy is not recommended while breastfeeding. It may pose a risk to the fetus during pregnancy, especially in the second and third trimesters. Extra caution and monitoring are needed if you have reduced kidney function, are older, take a loop diuretic or are at risk of dehydration or ketoacidosis. Ketoacidosis must be assessed regardless of blood glucose levels; stop Synjardy if it is suspected and seek medical assessment. Urinary and genital infections require prompt assessment and treatment. Seek immediate medical attention for pain, tenderness, redness or swelling around the genitals or the area between the genitals and anus, together with fever or feeling unwell, as these may indicate a serious infection. Lower-limb infections or ulcers also need monitoring and treatment. Low blood sugar risk may be increased in adults taking insulin or medicines that stimulate insulin release. In children aged 10 years and older, this risk was higher regardless of insulin use. Serious allergic reactions, including angioedema, require stopping Synjardy and prompt treatment. Metformin may lower vitamin B12 levels, so periodic blood monitoring is needed. Premenopausal women should be aware of the potential for unintended pregnancy.
Interactions
Some medicines and alcohol can affect Synjardy or increase the risk of side effects. Tell your doctor if you use: • Topiramate, zonisamide, acetazolamide or dichlorphenamide. These may increase the risk of lactic acidosis, a buildup of lactic acid in the blood. More frequent monitoring may be needed. • Ranolazine, vandetanib, dolutegravir or cimetidine. These can slow the removal of metformin from the body and may increase the risk of lactic acidosis. • Diuretics (water tablets). These can increase urination and the risk of fluid loss. Your doctor may check your fluid levels and kidney function before and during treatment. • Insulin or medicines that stimulate insulin release, such as sulfonylureas. Combining these with Synjardy increases the risk of low blood sugar. Your prescriber may need to adjust your treatment. • Lithium. Synjardy may lower lithium levels in the blood. More frequent blood tests may be needed when Synjardy is started or your prescription changes. Some medicines can raise blood sugar and make it harder to control. These include thiazides and other diuretics, corticosteroids, phenothiazines, thyroid medicines, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers and isoniazid. Closer blood sugar monitoring may be needed when these medicines are started or stopped. Avoid excessive alcohol intake, as alcohol can increase metformin’s effect on how the body processes lactate. Synjardy causes glucose to pass into the urine, so urine glucose tests should not be used to monitor blood sugar control. The 1,5-anhydroglucitol (1,5-AG) blood test is also unreliable during treatment. Your doctor should use other monitoring methods.
Using Synjardy
Dosing
Dosing is set by your prescriber. Each health care professional may prescribe medication differently according to a patient's medical history and condition, so follow the directions on your prescription label and speak to your doctor or pharmacist before changing anything.
Storage
Store below 25°C in a dry place, in the original pack, away from direct light and moisture. Do not keep it in a bathroom. Keep all medicines out of the sight and reach of children.
Clinical information on this page is summarised from the US FDA label SYNJARDY (EMPAGLIFLOZIN AND METFORMIN HYDROCHLORIDE) TABLET [BOEHRINGER INGELHEIM PHARMACEUTICALS, INC.] (DailyMed, retrieved 19 September 2026).
Patient information and references
Official and supporting information to read alongside advice from your prescriber or pharmacist.
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