From the Guidelines
Patients taking Jardiance (empagliflozin) and verapamil should be closely monitored for potential interactions, as verapamil may increase blood levels of empagliflozin, enhancing its effects and side effects. When taken together, verapamil may inhibit P-glycoprotein, a transport protein that helps remove empagliflozin from the body, potentially leading to increased blood sugar-lowering effects and side effects such as hypoglycemia, increased urination, or dehydration 1.
Key Considerations
- Patients taking both medications should watch for signs of hypoglycemia (low blood sugar) such as dizziness, confusion, or shakiness, and increased urination or dehydration.
- Blood glucose levels should be monitored more frequently when starting or adjusting either medication.
- Despite this interaction, these medications can often be used together with proper monitoring.
- Patients should not stop either medication without consulting their healthcare provider, and should ensure all their doctors are aware of all medications they're taking, including over-the-counter drugs and supplements.
Mechanism of Interaction
Verapamil is a moderate CYP3A4 inhibitor and also inhibits P-glycoprotein, which can increase the blood levels of empagliflozin, potentially enhancing its effects and side effects 1. This interaction is similar to the interaction between verapamil and statins, where verapamil can increase the blood levels of certain statins, such as lovastatin and simvastatin 1.
Clinical Implications
The potential interaction between Jardiance (empagliflozin) and verapamil highlights the importance of careful monitoring and management of patients taking these medications together. Healthcare providers should be aware of this potential interaction and take steps to minimize its effects, such as monitoring blood glucose levels and adjusting medication doses as needed. Patients should also be educated on the potential risks and benefits of taking these medications together and should be encouraged to report any signs of hypoglycemia or other side effects to their healthcare provider.
From the Research
Potential Interactions between Jardiance (Empagliflozin) and Verapamil
- The interaction between Jardiance (Empagliflozin) and Verapamil is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, it is known that Verapamil is a P-glycoprotein (P-gp) inhibitor and can interact with other drugs that are substrates of P-gp 2, 5, 6.
- Empagliflozin is a substrate of P-gp, but the studies provided do not specifically investigate the interaction between Empagliflozin and Verapamil 4.
- The diuretic action of Empagliflozin can lead to volume depletion and a fall in blood pressure, especially during co-administration with other diuretics or antihypertensive drugs, including calcium channel blockers like Verapamil 4, 5.
- Based on the available information, it is possible that concomitant administration of Empagliflozin and Verapamil may increase the risk of hypotension, volume depletion, or other adverse effects, but further studies are needed to confirm this interaction 4, 5.
Mechanism of Potential Interaction
- Verapamil, as a P-gp inhibitor, may increase the plasma concentrations of Empagliflozin by reducing its renal clearance 5, 6.
- The increased plasma concentrations of Empagliflozin may enhance its diuretic effect, leading to increased risk of volume depletion and hypotension, especially in patients with pre-existing renal impairment or those taking other diuretics or antihypertensive drugs 4, 5.
Clinical Implications
- Patients taking Empagliflozin and Verapamil concomitantly should be monitored for signs of hypotension, volume depletion, or other adverse effects 4, 5.
- The dosage of Empagliflozin may need to be adjusted in patients taking Verapamil to minimize the risk of adverse effects 4, 5.
- Further studies are needed to fully understand the potential interaction between Empagliflozin and Verapamil and to provide guidance on safe concomitant use 2, 3, 4, 5, 6.