Can I take Empagliflozin and Metformin together?

Why this happens

Both medicines work in different ways to lower your blood sugar. Metformin reduces the amount of sugar your liver produces, while empagliflozin helps your kidneys remove sugar through your urine. Because they both lower blood sugar, their effects are added together. Empagliflozin also causes you to lose more fluid, which can lead to dehydration.

What you should do

It is very common for these two medicines to be prescribed together (sometimes in a single tablet). You should monitor your blood sugar levels regularly as advised by your doctor. Stay well-hydrated by drinking plenty of water. Seek medical help immediately if you feel very sick, have stomach pain, or notice a fruity smell on your breath, as these can be signs of ketoacidosis.

Important precautions

Dehydration and Diabetic Ketoacidosis (DKA)

You must stop taking empagliflozin and seek urgent medical help if you become very unwell, lose your appetite, or have persistent vomiting/diarrhoea. This is to prevent a rare but serious condition called ketoacidosis, which can occur even if your blood sugar levels are normal.

Severe illness, dehydration, or excessive alcohol intake

You must stop taking metformin and seek urgent medical help if you experience severe vomiting, diarrhoea, or high fever. These can lead to lactic acidosis, a rare but life-threatening build-up of acid in the blood.

Fournier’s gangrene - empagliflozin

Seek immediate medical attention if you experience severe pain, tenderness, redness, or swelling in the genital or anal area, accompanied by fever or a general feeling of being unwell.

Surgery or medical procedures

You must inform your surgeon or dentist you are taking these medicines. Empagliflozin usually needs to be stopped at least 3 days before major surgery to prevent ketoacidosis, and metformin may need to be paused if you are having an X-ray or scan involving iodine contrast.

Foot ulcers

Check your feet regularly and tell your doctor immediately if you develop any sores, ulcers, or infections, as empagliflozin may increase the risk of lower limb amputations if foot care is neglected.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol when taking these medicines. For Metformin, alcohol increases the risk of a rare but serious condition called lactic acidosis. For Empagliflozin, alcohol can increase the risk of diabetic ketoacidosis (DKA) and dehydration. Alcohol also makes it harder to manage your blood sugar levels.

Water and fluids

It is essential to drink plenty of water and stay well-hydrated. Empagliflozin works by removing sugar through your urine, which increases the amount of fluid you lose. This can lead to dehydration and low blood pressure if you do not drink enough fluids.

General food advice

Metformin should be taken with or immediately after a meal. This helps to reduce common side effects such as stomach upset, nausea, and diarrhoea.

Vitamin B12 absorption

Long-term use of metformin can prevent your body from absorbing enough vitamin B12 from your food. You may need to have your B12 levels checked by your doctor or take a supplement if you develop symptoms like extreme tiredness or a sore tongue.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.