Is it safe to take Jardiance and metformin together?

Are Jardiance and metformin the same? | Is Jardiance or metformin better? | Side effects | Risks | Comparison | Taking Jardiance and metformin together

Diabetes mellitus is a disorder in which the body does not produce enough insulin or the body does not respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. In Type 1 diabetes the pancreas does not produce enough insulin, and it must be treated by injecting or inhaling insulin. In Type 2 diabetes the body’s ability to produce or utilize insulin is impaired, resulting in high blood glucose levels. Over a period of time, untreated high blood glucose levels, a condition known as hyperglycemia, can lead to serious health problems such as heart disease, kidney disease, and stroke. Fortunately, there are many treatment options for people with Type 2 diabetes and two of the most commonly prescribed medications are Jardiance and metformin.

Are Jardiance and metformin the same thing?

Jardiance and metformin are similar in that they are both intended for use only in Type 2 diabetes (not for Type 1), they are both taken orally, and they are both part of a blood glucose lowering treatment plan that includes diet and exercise. They are, however, two different types of anti-diabetic medicines and they have different mechanisms of action.

Metformin, which was approved for use by the U.S. Food and Drug Administration (FDA) in 1995, is often prescribed as a first-line treatment for Type 2 diabetes, as recommended by many expert diabetes treatment guidelines. Metformin works by reducing glucose production in the liver and by increasing the body’s sensitivity to insulin. Metformin is available as a generic, making it relatively inexpensive. It is often combined with other medications that are used to treat Type 2 diabetes. Metformin has been available in the past under the brand names Fortamet, Glucophage, Glucophage XR, Glumetza, and Riomet.

Jardiance (generic name empagliflozin), a member of a relatively new anti-diabetic class of medicines called sodium glucose co-transporter 2 (SGLT2) inhibitors, was approved by the FDA in 2014. It lowers blood sugar levels by blocking the reabsorption of glucose in the kidneys and increasing glucose excretion in urine. In clinical trials, Jardiance demonstrated a reduction in the risk of major cardiovascular events such as heart attacks and strokes in people with Type 2 diabetes who also had cardiovascular risk factors. Jardiance, marketed by Boehringer Ingelheim and Eli Lilly and Company, is only available as the branded product and is considered expensive, particularly for those without insurance.

Is Jardiance or metformin better?

Jardiance and metformin are two of many antidiabetic medications that are available to treat Type 2 diabetes. Both have been shown to be very effective at maintaining stable blood glucose levels and lowering hemoglobin A1C (also known as HbA1c), a simple blood test that measures average blood glucose levels over the previous 3 months. 

Although there are some similarities between Jardiance and metformin, there are also many differences. Not every diabetes medication is appropriate for every patient. Healthcare professionals are trained to decide which treatment, or combination of treatments, will work the best for individual patients. But it is important to understand the differences between Jardiance and metformin so that patients can better understand the reasons for their healthcare professionals’ choices.

The American Diabetes Association (ADA) Standards of Medical Care in Diabetes recommend metformin as the first-line drug therapy, along with diet and exercise, for patients with Type 2 diabetes. The advantages of metformin include efficacy in lowering blood glucose levels and HbA1c, improving the body’s response to insulin, the potential for weight loss, the low risk of causing lower blood sugar (hypoglycemia), and its availability as a generic, making it relatively inexpensive. 

For those individuals with Type 2 diabetes and established cardiovascular disease or heart failure, the ADA recommends the use of an SGLT2 inhibitor, such as Jardiance, to reduce the risk of hospitalization and death from cardiovascular events. Jardiance is only available as the branded medicine, and since there is no generic it can be expensive, even with insurance.

Drug class

Metformin is the only member of the medication class called biguanides. Brand-name versions of metformin include Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet, and Riomet ER. Many of the brand-name versions, including Glucophage, Glucophage XR, and Fortamet, are no longer available in the U.S. Metformin can be used alone or combined with other anti-diabetic medications. 

Jardiance (empagliflozin) belongs to a group of medications called sodium glucose co-transporter 2 (SGLT2) inhibitors. Other SGLT2 inhibitors include Invokana (canagliflozin) and Farxiga (dapagliflozin). Jardiance is available as a standalone drug and as a combination tablet with metformin (brand names Synjardy and Synjardy XR)

Standard dosages 

Metformin is available as an oral tablet in strengths of 500 mg, 850 mg, and 1000 mg. It’s available as an extended-release tablet in strengths of 500 mg, 750 mg, 1000 mg, and as an oral solution (brand-name Riomet) and extended-release liquid formulation (brand-name Riomet ER) in strengths of 500 mg/5ml. The typical starting dose of metformin is 500 mg two times daily or 850 mg taken once daily. Metformin should be taken with meals. Based on the response, the dosage may be increased by 500 mg weekly or 850 mg every two weeks, up to a total of 2,550 mg taken per day in divided doses. The extended-release starting adult dose is 500 mg once daily which may be increased by 500 mg weekly to a maximum of 2000 mg daily.

Jardiance is available as an oral tablet in strengths of 10 mg and 25 mg. The starting dose is 10 mg taken once daily. If blood glucose levels are not well managed at the 10 mg dose, it may be increased to the maximum dose of 25 mg taken once daily. Jardiance should be taken in the morning and can be taken with or without food.

Cost

Metformin is available as a generic which means it is relatively cheap. Metformin tablets range in cost from about $4 to over $150 for 60, 1000 mg tablets without insurance. 

Jardiance costs approximately $570 for a 30-day supply without insurance. Jardiance may be covered by insurance, however, prices vary widely depending on the insurance or Medicare Part D plan.

Additional savings can be added to Jardiance, metformin, and other prescriptions by using a SingleCare discount card at nearby participating pharmacies. 

Side effects

Stomach trouble is the most common side effect when taking metformin. Taking metformin with food may help reduce the severity. Common adverse events include the following:

• Bloating
• Gas
• Diarrhea
• Stomach pain
• Constipation
• Reduced appetite

Less common, more serious side effects of metformin include:

• Lactic acidosis (lactic acid build up in the bloodstream)
• Vitamin B12 deficiency
• Hypoglycemia (low blood sugar)

Metformin has an FDA-mandated “boxed warning,” also called a black box warning, due to an increased risk of developing lactic acidosis, a dangerous condition caused by the buildup of lactic acid in the bloodstream. Many of the symptoms are similar to some of the common side effects of metformin, such as stomach pain, dizziness, and weakness. Other symptoms may include numbness or a cold feeling in the arms or legs, changes in heart rate, or trouble breathing. Immediate medical attention may be required when showing symptoms of lactic acidosis.

The most common side effects of Jardiance are urinary tract infections (burning or painful urination, bloody urine, urgency) and fungal infections (e.g., yeast infections) of the vagina or penis. Other common side effects include:

• Upper respiratory infections 
• Increased urination
• Elevated levels of fats or cholesterol in the blood
• Joint pain
• Nausea 
• Kidney problems

Less common, more serious side effects of Jardiance include:

• Reduced blood volume and low blood pressure
• Dehydration 
• Fournier’s gangrene (a serious bacterial infection in the genital or anal area)
• Hypoglycemia (low blood sugar)

This is not an exhaustive list of side effects of metformin and Jardiance. A healthcare professional is the best source when seeking medical advice about what adverse reactions to expect and how to address them. Reading the medication guide provided by the pharmacy will offer additional drug information. 

RELATED: Metformin side effects | Jardiance side effects

Risks and restrictions

The overall safety profiles of both metformin and Jardiance are good when taken as prescribed, however, there are certain situations and conditions in which a person should not receive these medicines.

Metformin should not be used, or should be used cautiously, with any of the following conditions:

• Hypersensitivity (allergic reactions) to metformin
• Acute or chronic metabolic ketoacidosis, including diabetic ketoacidosis
• Severe kidney or liver problems 
• Recent heart attack or heart failure
• Excessive alcohol intake 

There have been no adequate and well-controlled studies on the use of metformin in pregnant women and safety data is limited as to whether there is an association regarding birth defects or miscarriages. Studies have shown that metformin is excreted in human milk, but it is not known if there are any effects on breastfed infants. 

Jardiance should not be used, or should be used cautiously, with any of the following conditions:

• Hypersensitivity (allergic reactions) to Jardiance
• Kidney dialysis 

There have been no adequate and well-controlled studies on the use of Jardiance in pregnant women. Based on data from animal studies, Jardiance is not recommended during the second and third trimesters of pregnancy. Studies have shown that Jardiance is excreted in human milk and due to the potential for serious adverse reactions in a breastfed infant, the use of Jardiance is not recommended while breastfeeding.

A woman’s healthcare provider is the best source of information when making medication decisions to manage Type 2 diabetes during pregnancy or while breastfeeding.

RELATED: What a pharmacist wants you to know about breastfeeding and medications

Taking Jardiance and metformin together

Once someone is diagnosed with Type 2 diabetes, the healthcare professional will likely recommend starting on an antidiabetic medication, along with diet and exercise, to control blood glucose levels. Often the initial medicine prescribed is metformin. But even if lifestyle changes are adopted, and the medicine is taken as directed, blood glucose levels may still worsen over time. This is because Type 2 diabetes is a progressive disease and many people eventually need more than one drug to maintain optimal blood glucose levels.

When one medication isn’t enough to control blood glucose levels, the healthcare professional will work to find the best combination therapy for each individual patient. In these situations, it is very common to stay on metformin and add another medication that treats diabetes by a different mechanism of action. 

The decision on which new medication to add will depend on what blood glucose control situations need to be addressed. Some medicines control blood sugar spikes (known as hyperglycemia) that come following a meal, for example. Other medications are more effective at stopping drops in blood glucose levels between meals. Some may help if further weight loss is needed. The decision also may depend on whether the patient is taking other medicines for different health issues. 

The combination of Jardiance and metformin, along with diet and exercise, is commonly used to treat Type 2 diabetes in patients who also have known heart disease, including congestive heart failure. In a clinical study, the two medications taken together significantly lowered HbA1c and reduced the risk of cardiovascular death. 

Taking both drugs at the same time has been made even easier with the introduction of Synjardy (empagliflozin and metformin hydrochloride), a brand-name drug that combines Jardiance and metformin into one oral tablet. Synjardy is taken twice daily with food to help reduce the chance of an upset stomach, and it is available in four different strengths. The combination is also available in an extended-release oral tablet called Synjardy XR. It’s taken once daily in the morning with food and also is available in four different strengths.

 The most common side effects when combining metformin and Jardiance, and when taking the combination tablet Synjardy, are similar to the common side effects of each individual medication. They include urinary tract infections, female genital infections, diarrhea, nausea, vomiting, gas, stomach pain, indigestion, weakness, headache, stuffy or runny nose and sore throat. These are not all the possible side effects of the combination therapy For more information on taking a prescribed metformin and Jardiance combination, it’s always best to consult a trusted healthcare professional.