From the Guidelines
Yes, a patient with Type 2 Diabetes Mellitus (T2DM) can take Synjardy XR at bedtime, but it's crucial to consider the potential for nighttime bathroom trips due to the empagliflozin component and ensure a small snack is taken to mitigate gastrointestinal side effects from metformin. Synjardy XR, which combines empagliflozin (an SGLT2 inhibitor) and metformin extended-release, is designed to be taken once daily with a meal, but flexibility in timing can be beneficial for patient adherence [no direct evidence from 1 supports this specific timing for Synjardy XR, but the concept of flexibility in medication timing is relevant in diabetes management]. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) emphasize the importance of individualizing treatment plans in their 2022 consensus report 1, which, while not directly addressing Synjardy XR timing, underscores the need for personalized approaches to diabetes care.
When considering the administration of Synjardy XR at bedtime, it's essential to weigh the benefits of improved adherence against potential disruptions in sleep patterns due to increased urination, a common side effect of SGLT2 inhibitors like empagliflozin. Patients should be advised to monitor their blood glucose levels closely and discuss any concerns or adjustments to their medication regimen with their healthcare provider. The provider may recommend alternative timing strategies based on individual patient factors, such as lifestyle, response to medication, and presence of other health conditions.
Key considerations for patients taking Synjardy XR at bedtime include:
- Ensuring a consistent timing schedule to maintain medication efficacy
- Having a small snack to reduce gastrointestinal side effects associated with metformin
- Being aware of the potential for increased nighttime urination and planning accordingly
- Regularly monitoring blood glucose levels and adjusting the treatment plan as needed in consultation with a healthcare provider. While 1 does not provide direct guidance on the timing of Synjardy XR administration, its emphasis on personalized and flexible management strategies supports the consideration of bedtime dosing as a viable option for some patients.
From the Research
Administration of Synjardy XR
- Synjardy XR is a combination of empagliflozin and metformin, used to treat Type 2 Diabetes Mellitus (T2DM) 2.
- The studies provided do not specifically address the administration of Synjardy XR at bedtime (Hour of Sleep, HS).
- However, the efficacy and safety of empagliflozin, a component of Synjardy XR, have been studied in various dosing regimens, including once-daily and twice-daily administration 3, 4, 5.
Dosing Regimens
- A study comparing once-daily and twice-daily empagliflozin regimens found that both regimens were well-tolerated and had equivalent therapeutic effects when used as add-on to metformin in patients with T2DM 3.
- Another study investigated the long-term efficacy and safety of empagliflozin as add-on to metformin plus sulphonylurea in patients with T2DM, and found that empagliflozin led to sustained reductions in HbA1c and weight versus placebo 5.
Safety and Efficacy
- The combination of empagliflozin and metformin has been shown to improve glucose control, reduce body weight and arterial blood pressure, and have a minimal risk of hypoglycemia 2.
- However, caution may be required in fragile elderly patients and in patients with severe impaired renal function 2.
- The EMPA-REG OUTCOME study demonstrated that empagliflozin may reduce major adverse cardiac events, cardiovascular mortality, and all-cause mortality in patients with T2DM and established cardiovascular disease 4.