Adults

Initial dose is individualized based on patient's current treatment and tolerance, usually starting with lower doses of both components once daily with a meal. Maximum recommended daily dose for empagliflozin is 25 mg and for metformin is 2000 mg.

Elderly

Careful dose titration, consider age-related renal function decline. Avoid in severe renal impairment.

Renal_impairment

Not recommended for patients with eGFR <30 mL/min/1.73 m². Dose adjustment may be required for eGFR between 30 and 45 mL/min/1.73 m².

Onset

Within hours for blood glucose lowering.

Excretion

Empagliflozin: Approximately 50% renally excreted, 50% via feces. Metformin: Primarily excreted unchanged in urine.

Half life

Empagliflozin: Approximately 12.4 hours. Metformin XR: Approximately 7-17 hours (plasma elimination).

Absorption

Empagliflozin: Rapidly absorbed, Cmax reached within 1.5 hours. Metformin XR: Extended absorption, Cmax reached within 7 hours, bioavailability ~50-60%.

Metabolism

Empagliflozin: Primarily metabolized via glucuronidation by UGT1A8, UGT1A3, UGT1A9, UGT2B7, UGT2B4. Metformin: Not metabolized in the liver.

Alcohol

Increases risk of lactic acidosis (with metformin). Avoid excessive alcohol intake.

Diuretics

May increase risk of dehydration and hypotension, especially with empagliflozin. Monitor fluid status and blood pressure.

Iodinated Contrast Agents

Temporarily discontinue metformin at the time of or prior to an iodinated contrast imaging procedure in patients with eGFR between 30 and 60 mL/min/1.73 m².

Carbonic Anhydrase Inhibitors

May increase risk of lactic acidosis (with metformin).

Insulin and Insulin Secretagogues

Increased risk of hypoglycemia when used with empagliflozin. Dose adjustment may be required.