Can Synjardy (empagliflozin and metformin) cause gastritis as a side effect?

Synjardy and Gastritis Side Effects

Yes, Synjardy (empagliflozin and metformin) can cause gastritis as a side effect, primarily due to the metformin component which is known to cause gastrointestinal side effects including gastritis.

Metformin Component and GI Side Effects

Metformin, one of the two active ingredients in Synjardy, is well-documented to cause gastrointestinal side effects:

• The American Diabetes Association recognizes that the principal side effects of metformin are gastrointestinal intolerance including bloating, abdominal discomfort, and diarrhea 1
• These GI side effects can manifest as gastritis in some patients
• A study specifically examining the relationship between gastritis and metformin found that pre-existing asymptomatic chronic gastritis was associated with increased metformin-related gastrointestinal side effects 2

Empagliflozin Component

The empagliflozin component of Synjardy has a different side effect profile:

• Common side effects of SGLT2 inhibitors like empagliflozin include genital infections, risk of kidney failure, and diabetic ketoacidosis 3
• Gastrointestinal side effects are not prominently associated with empagliflozin alone
• When empagliflozin is used as monotherapy, it has fewer GI side effects compared to metformin 4, 5

Managing Gastritis with Synjardy

If experiencing gastritis while taking Synjardy, consider these approaches:

1. Dose titration: Start with a lower dose and gradually increase to reduce GI side effects 1
2. Take with meals: Administering Synjardy with food can help mitigate gastric irritation 6
3. Extended-release formulation: If available, extended-release metformin formulations have been shown to reduce GI side effects compared to immediate-release versions 7
4. Endoscopic evaluation: Consider endoscopic evaluation if symptoms persist, as pre-existing gastritis may worsen with metformin therapy 2

Risk Factors for Gastritis with Synjardy

Patients with the following conditions may be at higher risk for developing gastritis with Synjardy:

• Pre-existing asymptomatic chronic gastritis 2
• History of GI disorders
• Concurrent use of medications that can irritate the gastric mucosa (NSAIDs, corticosteroids)
• H. pylori infection

Alternative Medications

If gastritis is severe or persistent with Synjardy:

• Consider alternative diabetes medications with fewer GI side effects, such as DPP-4 inhibitors 6
• For patients requiring the SGLT2 inhibitor benefits, consider empagliflozin monotherapy instead of the combination 4
• GLP-1 receptor agonists may be an alternative, though they can also cause GI side effects 1

Monitoring and Follow-up

• Monitor for symptoms of gastritis including epigastric pain, nausea, vomiting, and loss of appetite
• If symptoms persist despite mitigation strategies, medication change may be necessary
• Evaluate for H. pylori infection, which may exacerbate metformin-induced gastritis

Gastritis is a recognized side effect of Synjardy, primarily attributed to the metformin component. Management strategies include dose titration, administration with meals, and consideration of extended-release formulations when available. If symptoms persist, alternative diabetes medications with lower risk of GI side effects should be considered.