Drug Class: SGLT-2 Inhibitor + Biguanide Combination (Extended-Release) | Form: Oral Extended-Release Tablet | Prescription Status: Prescription Only (Rx) — DRAP Registered
What is Diajard Mxr 12.5/1000mg Tablet?
Diajard Mxr 12.5/1000mg is a fixed-dose dual combination extended-release tablet containing Empagliflozin 12.5mg and Metformin Hydrochloride 1000mg — two clinically proven diabetes medicines targeting blood sugar through entirely different and complementary mechanisms. The 12.5mg Empagliflozin dose represents the standard therapeutic strength — offering stronger glucose elimination through urine compared to the 5mg starting dose, while Metformin Extended-Release works in the liver to reduce glucose production with a smoother release that minimises stomach side effects. Together they provide more complete 24-hour blood sugar control, modest weight reduction, and mild blood pressure lowering — all alongside diet and exercise for the management of Type 2 Diabetes (ذیابیطس ٹائپ 2) in adults.
What is Diajard Mxr 12.5/1000mg Used For?
- Type 2 Diabetes Mellitus — improving blood sugar control in adults when diet, exercise, and single-agent therapy are insufficient (ذیابیطس ٹائپ 2 میں شوگر کا کنٹرول)
- Step-up therapy — for patients already on Empagliflozin 5mg or Metformin alone requiring stronger glycaemic control
- Dual oral therapy — replacing separately taken Empagliflozin 12.5mg and Metformin as a single convenient extended-release tablet
- Cardiovascular risk reduction — Empagliflozin at therapeutic doses has demonstrated reduction in cardiovascular death and hospitalisation for heart failure in Type 2 Diabetes patients with established cardiovascular disease
- Weight management support — Empagliflozin at 12.5mg promotes meaningful weight loss by eliminating excess glucose calories through urine
- It is not used for Type 1 Diabetes or diabetic ketoacidosis
How Does Diajard Mxr 12.5/1000mg Work?
Empagliflozin 12.5mg — SGLT-2 Inhibitor: The kidneys normally filter glucose out of the blood and reabsorb almost all of it back into the body through a protein called SGLT-2 (sodium-glucose co-transporter 2). Empagliflozin at 12.5mg blocks this SGLT-2 protein more completely than the 5mg dose — preventing a greater amount of glucose reabsorption and causing more excess sugar to be eliminated directly through urine. This insulin-independent mechanism lowers blood sugar without relying on the pancreas, making dangerous hypoglycaemia much less likely. The increased glucose loss through urine also produces greater calorie loss contributing to more meaningful weight reduction, and the associated sodium excretion delivers a clinically useful mild blood pressure lowering effect.
Metformin HCl Extended-Release 1000mg — Biguanide: Metformin reduces the amount of glucose the liver produces and releases into the bloodstream and improves muscle cell sensitivity to insulin — helping the body use its own insulin more effectively. The extended-release formulation releases Metformin gradually throughout the day — maintaining stable blood levels and significantly reducing the nausea, diarrhoea, and stomach discomfort that frequently accompany standard immediate-release Metformin tablets.
Combined Dual Effect: Empagliflozin eliminates excess glucose already circulating in the blood through the kidneys while Metformin reduces the liver's ongoing production of new glucose — two separate sources of elevated blood sugar addressed simultaneously for more complete and sustained glycaemic control throughout the day and night.
Dosage and Administration
⚠️ Always take exactly as prescribed by your doctor. Never adjust the dose without medical advice. Always take with food. Never crush or chew — extended-release tablet.
| Indication | Usual Adult Dose | Frequency | Maximum Daily Dose |
|---|---|---|---|
| Type 2 Diabetes | 1 tablet (12.5/1000mg) | Once or twice daily | As prescribed |
Critical Dosing Rules:
- Kidney function (eGFR) must be checked before starting and monitored regularly — Empagliflozin 12.5mg requires adequate kidney function to work effectively and Metformin is unsafe in significant kidney impairment
- Do not use if eGFR is below 45 mL/min — both components carry kidney-related restrictions at this level
- Empagliflozin must be temporarily stopped before any major surgery, serious illness, prolonged fasting, or low-carbohydrate diet — risk of diabetic ketoacidosis even with near-normal blood sugar
- Metformin must be stopped before iodinated contrast dye procedures (CT scans) and restarted only after kidney function is confirmed normal — minimum 48 hours after the procedure
- If combined with insulin or a sulphonylurea, dose reduction of those medicines is usually required to prevent hypoglycaemia
How to Take:
- Swallow the tablet whole with a full glass of water — never crush, split, or chew under any circumstances
- Always take with food or immediately after a meal — significantly reduces Metformin-related stomach discomfort
- Take at the same time each day for consistent blood sugar control
- Maintain good daily fluid intake — Empagliflozin at 12.5mg increases urination and raises dehydration risk, particularly in hot weather or during illness
- If a dose is missed, take it as soon as remembered the same day — skip entirely if it is already the next day; never double the dose
Active Ingredients
| Ingredient | Strength per Tablet |
|---|---|
| Empagliflozin | 12.5mg |
| Metformin Hydrochloride (Extended-Release) | 1000mg |
Who Should NOT Take Diajard Mxr 12.5/1000mg?
Do not take if you:
- Are allergic to Empagliflozin, Metformin, or any ingredient in the tablet
- Have Type 1 Diabetes or diabetic ketoacidosis
- Have moderate to severe kidney disease (eGFR below 45 mL/min)
- Have severe liver disease
- Are severely dehydrated or have very low blood volume
- Drink excessive alcohol regularly
- Are having surgery requiring general anaesthesia — temporarily stop before the procedure
- Are under 18 years of age
- Are pregnant or breastfeeding
Always consult your doctor before taking Diajard Mxr if you have:
- Mild kidney impairment — close monitoring and possible dose adjustment required
- Recurrent urinary tract infections (پیشاب کی نالی کا بار بار انفیکشن) — higher glucose in urine at 12.5mg increases infection risk more than lower doses
- History of genital fungal infections — risk is higher with increased urinary glucose at 12.5mg
- Established cardiovascular disease or heart failure (دل کی بیماری) — inform your cardiologist; Empagliflozin has specific cardiovascular benefits at therapeutic doses
- History of pancreatitis (لبلبے کی سوزش)
- Low blood pressure or are currently on diuretics — dehydration and hypotension risk increases with 12.5mg Empagliflozin
- Are taking insulin or sulphonylureas — hypoglycaemia risk increases significantly
- Are planning prolonged fasting, very low carbohydrate diet, or major surgery — ketoacidosis risk
Side Effects
Common Side Effects:
- Urinary tract infections — burning or pain during urination, increased frequency (پیشاب کی نالی کا انفیکشن) — more common at higher Empagliflozin doses
- Genital fungal infections — itching or discharge in genital area — higher risk at 12.5mg due to increased urinary glucose
- Increased urination — expected and more pronounced at 12.5mg than 5mg dose
- Nausea or mild stomach discomfort — significantly reduced with extended-release Metformin formulation
- Mild dizziness — particularly on standing, from blood pressure lowering effect
- Metallic taste in mouth — Metformin related; usually temporary and improves with continued use
Serious Side Effects — Stop Taking and Seek Medical Help Immediately:
- Diabetic ketoacidosis (DKA) — nausea, vomiting, stomach pain, extreme tiredness, difficulty breathing, fruity-smelling breath — can occur even with near-normal blood sugar levels with SGLT-2 inhibitors; life-threatening emergency (طبی ہنگامی صورتحال)
- Lactic acidosis — rare but life-threatening Metformin complication; severe muscle pain, difficulty breathing, stomach pain, feeling very cold, dizzy, or confused — seek emergency care immediately
- Fournier's gangrene — rare but serious bacterial infection of genital and surrounding tissue — severe pain, swelling, redness, or fever in genital region; seek emergency medical care without delay
- Severe urinary tract infection — high fever, back or flank pain, shaking — may indicate serious kidney infection (pyelonephritis) requiring immediate treatment
- Severe hypotension — extreme dizziness, fainting, or collapse — particularly in elderly, dehydrated, or diuretic-treated patients
- Severe allergic reaction — swelling of face, lips, tongue or throat, difficulty breathing, widespread rash (یہ طبی ہنگامی صورتحال ہے)
- Acute kidney injury — significantly reduced urination, extreme fatigue, severe ankle swelling — stop immediately and seek urgent medical care
Drug Interactions
| Medicine / Substance | Possible Interaction |
|---|---|
| Insulin or Sulphonylureas (e.g., Glimepiride, Glibenclamide) | Increased hypoglycaemia risk — dose reduction of insulin or sulphonylurea usually required when combining with Empagliflozin 12.5mg |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Additive fluid loss with Empagliflozin — increased dehydration, low blood pressure, and kidney impairment risk; monitor closely |
| Iodinated contrast dye (CT/X-ray imaging) | Metformin must be stopped before and 48 hours after contrast procedure — acute kidney injury and lactic acidosis risk |
| ACE Inhibitors / ARBs (e.g., Enalapril, Losartan) | Combined fluid loss with Empagliflozin — increased low blood pressure and kidney stress risk; monitor kidney function regularly |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduce kidney blood flow — increase Metformin accumulation and kidney impairment risk; avoid regular use |
| Corticosteroids (e.g., Prednisolone) | Raise blood sugar and directly counteract diabetes control — monitor glucose levels closely |
| Alcohol (شراب) | Increases lactic acidosis risk with Metformin and raises ketoacidosis risk with Empagliflozin — avoid completely |
| Cimetidine | Reduces Metformin clearance — increases Metformin blood levels; monitor for increased side effects |
| Rifampicin | Reduces Empagliflozin blood levels — may reduce its blood sugar lowering effectiveness; inform your doctor |
Storage Instructions
- Store below 25°C in a cool, dry place
- Protect from moisture and direct sunlight
- Keep in original packaging until use
- Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں)
- Do not use after the expiry date printed on the pack
Frequently Asked Questions (FAQs)
Q: What is the difference between Diajard Mxr 5/1000mg and Diajard Mxr 12.5/1000mg? The only difference is the Empagliflozin dose — 12.5mg is the standard therapeutic strength providing stronger glucose elimination and greater cardiovascular benefit than the 5mg starting dose.
Q: Why must I never crush or chew Diajard Mxr 12.5/1000mg tablets? Crushing destroys the extended-release mechanism of Metformin — releasing the full 1000mg dose at once and causing severe nausea, stomach pain, and significantly increased side effects.
Q: Can Diajard Mxr 12.5/1000mg cause low blood sugar on its own? Neither Empagliflozin nor Metformin alone typically causes hypoglycaemia — however the risk increases significantly when combined with insulin or sulphonylurea medicines; monitor blood sugar closely.
Q: Why must Diajard Mxr be stopped before a CT scan with contrast dye? Contrast dye can temporarily reduce kidney function — if Metformin accumulates due to impaired kidney clearance it can cause lactic acidosis, a rare but life-threatening condition requiring immediate medical attention.
Medical Disclaimer: This information is for general awareness only and does not replace advice from your doctor or pharmacist. Type 2 Diabetes requires ongoing medical supervision — never adjust or stop your diabetes medication without consulting your healthcare provider.