Does Jardiance (Empagliflozin) interact with Cellcept (Mycophenolate mofetil)?

Jardiance (Empagliflozin) and CellCept (Mycophenolate Mofetil) Interaction

No significant direct pharmacokinetic interaction has been documented between Jardiance (empagliflozin) and CellCept (mycophenolate mofetil), making their concurrent use generally safe from an interaction perspective.

Mechanism of Action and Metabolism

Empagliflozin (Jardiance)

• SGLT2 inhibitor that reduces renal tubular glucose reabsorption
• Primarily used for type 2 diabetes management
• Also has cardiovascular and renal protective effects

Mycophenolate Mofetil (CellCept)

• Antimetabolite immunosuppressant that inhibits purine nucleotide synthesis
• Leads to preferential inhibition of T and B lymphocytes
• Commonly used in transplant recipients to prevent organ rejection 1

Evidence on Potential Interactions

The available evidence suggests minimal interaction risk between these medications:

1. According to transplantation guidelines, mycophenolate mofetil does not engage in significant drug-drug interactions with antidiabetic drugs 2.

2. While some antidiabetic medications have documented interactions with immunosuppressants, SGLT2 inhibitors like empagliflozin have limited interaction potential with mycophenolate specifically 2.

3. The primary interaction concerns with mycophenolate are:

   • Reduced bioavailability when co-administered with aluminum/magnesium hydroxide antacids
   • Reduced bioavailability when co-administered with cholestyramine 1

Important Considerations

Potential Indirect Effects

While direct pharmacokinetic interactions appear minimal, clinicians should be aware of:

1. Renal Function Impact:

   • Both medications can affect renal function
   • Empagliflozin has diuretic effects and can cause volume depletion 3
   • Mycophenolate dosing may need adjustment based on renal function 4

2. Metabolic Effects:

   • Empagliflozin can rarely cause euglycemic diabetic ketoacidosis, especially during acute illness 5
   • This risk should be monitored in immunosuppressed patients

3. Bone Marrow Effects:

   • Mycophenolate can cause bone marrow suppression 1
   • Monitor complete blood counts regularly

Monitoring Recommendations

When using these medications concurrently:

• Monitor renal function regularly
• Check electrolytes, particularly during illness or medication adjustments
• Be vigilant for signs of metabolic acidosis, especially during acute illness
• Continue standard therapeutic drug monitoring for mycophenolate when clinically indicated

Conclusion

The combination of empagliflozin and mycophenolate mofetil appears to have no significant direct pharmacokinetic interaction that would preclude their concurrent use. However, careful monitoring of renal function, metabolic parameters, and standard immunosuppression efficacy markers is recommended due to the individual effects of each medication.