What are the potential interactions between Jardiance (Empagliflozin), Ozempic (Semaglutide), and Coumadin (Warfarin)?

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Last updated: June 24, 2025 • View editorial policy

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From the Guidelines

Patients taking Jardiance (empagliflozin), Ozempic (semaglutide), and Coumadin (warfarin) together should be closely monitored for potential interactions, particularly the effects of Ozempic on warfarin absorption and the indirect effects of Jardiance on warfarin metabolism, as highlighted in studies on drug interactions affecting oral anticoagulant use 1.

Potential Interactions and Concerns

  • The combined use of Ozempic and Jardiance may increase the risk of hypoglycemia due to their synergistic effects on blood glucose levels.
  • Ozempic may delay gastric emptying, potentially affecting the absorption of warfarin, which necessitates more frequent INR monitoring, especially when starting or adjusting Ozempic doses, as warfarin's efficacy and safety are highly dependent on maintaining a therapeutic international normalized ratio (INR) range 1.
  • Jardiance can cause volume depletion and changes in kidney function, which might indirectly affect warfarin's metabolism by altering its clearance, thus potentially requiring adjustments in warfarin dosing to maintain therapeutic anticoagulation levels 1.

Monitoring and Management

  • Patients should be educated to monitor for signs of hypoglycemia (shakiness, confusion, sweating), unusual bleeding or bruising (indicating warfarin effects), and symptoms of dehydration (dizziness, lightheadedness).
  • Regular blood glucose monitoring and consistent vitamin K intake are essential to minimize the risk of bleeding complications associated with warfarin therapy.
  • Maintaining adequate hydration is crucial, especially for patients on Jardiance, to prevent volume depletion and potential acute kidney injury.
  • Any dose adjustments of Jardiance, Ozempic, or Coumadin should only be made under medical supervision, taking into account the patient's clinical status, renal function, and INR values.
  • Patients should inform all healthcare providers about their complete medication regimen to prevent potential complications arising from drug interactions.

From the Research

Potential Interactions between Jardiance, Ozempic, and Coumadin

  • The potential interactions between Jardiance (Empagliflozin), Ozempic (Semaglutide), and Coumadin (Warfarin) are complex and involve various mechanisms, including effects on pharmacokinetics and pharmacodynamics 2.
  • Studies have shown that empagliflozin does not have a significant effect on the pharmacokinetics of warfarin, and warfarin does not affect the pharmacokinetics of empagliflozin 3.
  • Semaglutide has also been shown to not have a significant effect on the pharmacokinetics of warfarin, and warfarin does not affect the pharmacokinetics of semaglutide 4, 5.
  • However, it is essential to monitor patients for changes in prothrombin time when adding or deleting any newly approved drug or any drug suspected to cause an interaction to patients on coumarin therapy, as the onset of the adverse prothrombin time response might be from between 1 to 2 days up to 3 weeks after starting a concomitant drug regimen 2.

Mechanisms of Interaction

  • Coumarin derivatives, such as warfarin, have a narrow therapeutic range and are prone to potentially life-threatening drug-drug interactions due to their high protein binding, cytochrome P450 dependent metabolism, and narrow therapeutic range 2.
  • Empagliflozin and semaglutide may affect the pharmacokinetics of warfarin through various mechanisms, including inhibition of the elimination of the eutomer S-(-)-warfarin or protein binding displacement 2.
  • However, studies have shown that empagliflozin and semaglutide do not have a significant effect on the pharmacokinetics of warfarin, suggesting that they can be co-administered without dosage adjustments of either drug 4, 3, 5.

Clinical Implications

  • The lack of significant interactions between empagliflozin, semaglutide, and warfarin suggests that they can be co-administered without dosage adjustments of either drug 4, 3, 5.
  • However, it is essential to monitor patients for changes in prothrombin time and adjust the dose of warfarin as needed to maintain therapeutic anticoagulation 2.
  • Healthcare providers should be aware of the potential interactions between these drugs and monitor patients closely to minimize the risk of adverse events 2, 4, 3, 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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