Short answer: Both pair an SGLT2 inhibitor with metformin and carry a boxed warning for lactic acidosis.12 Segluromet uses ertugliflozin and is for blood sugar in adults. Synjardy uses empagliflozin, adds heart and kidney uses in certain adults, is approved from age 10, and has a once-daily XR form. Segluromet is held 4 days before surgery, Synjardy 3. Neither label compares them.
| Segluromet | Synjardy | |
|---|---|---|
| Paired with metformin | Ertugliflozin1 | Empagliflozin2 |
| Approved for | Blood sugar control in adults with type 2 diabetes1 | Blood sugar control in adults and children 10 and older; heart and kidney uses in certain adults2 |
| How taken | Twice daily with meals1 | Synjardy twice daily with meals; Synjardy XR once daily with a morning meal2 |
| Maximum daily dose | Ertugliflozin 15 mg and metformin 2,000 mg1 | Empagliflozin 25 mg and metformin 2,000 mg2 |
| Kidney limits | Not recommended with an eGFR below 45; not used below 30 or on dialysis1 | Starting not recommended below 45; not used below 302 |
| Before surgery | Held at least 4 days, if possible1 | Held at least 3 days, if possible2 |
| Side effects in label trials | Female genital yeast infection 9.1% and 12.2% vs 3.0% on placebo1 | Female genital yeast infection 5.4% and 6.4% vs 1.5% on placebo2 |
| Missed dose | Take as soon as possible; do not double1 | Take as soon as possible; do not double2 |
| Boxed warning | WARNING: LACTIC ACIDOSIS1 | WARNING: LACTIC ACIDOSIS2 |
Mostly. Both list lactic acidosis, ketoacidosis even with blood sugar below 250 mg/dL, fluid loss, urinary and genital infections including Fournier's gangrene, low blood sugar with insulin or a sulfonylurea, lower limb amputation and lower vitamin B12.12 The Synjardy label adds that children 10 and older had more low blood sugar regardless of insulin.2 Added to metformin, low blood sugar was 7.2% and 7.8% on ertugliflozin vs 4.3% on placebo,1 and 1.8% and 1.4% on empagliflozin vs 0.5% on placebo.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Segluromet side effects, Synjardy side effects, the Segluromet and Synjardy dosing schedules and Synjardy vs Xigduo XR: how do the two SGLT2 and metformin tablets differ?.