Dapagliflozin and metformin (Oral)

Overview

What is Dapagliflozin and Metformin?

Dapagliflozin and Metformin oral combination drug therapy is a combination of the drugs Dapagliflozin and Metformin that have been formulated to work together in an extended release tablet oral medication that is available only through a physician's prescription.

Dapagliflozin and Metformin is specifically for patients who suffer from Type 2 Diabetes, also known as diabetes mellitus, in that it works to prevent the kidneys from absorbing glucose or blood sugar, lowering the level. The drug also works to reduce the amount of sugar that the stomach absorbs and slow the release of sugar stored by the liver, helping the patient's body consume sugar on a more normal level.

Patients who suffer from Type 1 Diabetes, also known as insulin-dependent diabetes, do not realize any benefit from Dapagliflozin and Metformin, as their disease operates in the body much differently.

How does Dapagliflozin and Metformin work?

Working in tandem, the combination of Dapagliflozin and Metformin, in conjunction with a good diet and exercise plan, can offer diabetes type two patients a way to control their blood sugar levels, offering them a more normal lifestyle. As the drug is a combination therapy, there are two main ingredients, each doing a specific job on the way the body uses glucose or sugar.

Dapagliflozin assists the patient's kidneys to get rid of sugar found in the blood stream. Metformin, on the other hand, works to actually slow the production of sugar in the liver while slowing the absorption rate by the intestines.

Dapagliflozin is an inhibitor of an enzyme known as SGLT2, sodium glucose transporter two, which is the enzyme responsible for most of the filtered sugar found in the blood stream. By inhibiting this transporter, Dapagliflozin lowers the sugar that is found in the bloodstream.

Metformin is a biguanide type of medication that is effective in preventing the liver from producing sugar, making the patient more sensitive to the insulin found in their bodies, thus reducing the amount of glucose that the intestines absorb. Working together, these to compounds are successful in regulating blood sugar effectively for most patients, provided they also follow a lifestyle plan that includes good nutrition and activity.

What is Type 2 Diabetes or Diabetes Mellitus?

Patients who suffer from Type 2 diabetes, also known as diabetes mellitus, have a condition wherein the body does not react to the insulin present in the bloodstream or perhaps the pancreas does not produce a normal level of insulin in the first place. This is opposed to Type 1 diabetes, in which the pancreas does not produce insulin at all. The reason Dapagliflozin and Metformin are effective only in Diabetes Mellitus sufferers is that there is actually insulin and glucose to work with, just requiring adjustment to levels, rather than no insulin at all.

Insulin is the enzyme that uses blood sugar for energy, as if it were a fuel. Excess sugar found in the bloodstream, when not used by the body for energy, is normally released by the organs as waste. People who suffer from diabetes do not have a normal means of removing the excess glucose from their blood. People who suffer from diabetes often have the following symptoms:

  • Very high thirst level
  • Increased urine production, especially at night
  • Fatigue
  • Loss of weight and bulk or muscle

Type 2 diabetes is frequently found in older patients and those who are obese; it is a far more common form of diabetes than type 1. Medications such as Dapagliflozin and Metformin, along with good nutritional practices and an exercise regime can offer type 2 diabetes patients a new lease on life by regulating their blood sugar and relieving their symptoms. Additionally, there are several long term health problems that diabetes type 2 can cause, which can be avoided with blood sugar regulation.

Conditions Treated

  • Diabetes Mellitus, Type 2 Diabetes

Type Of Medicine

  • Combination SGLT2 inhibitor and biguanide agent

Side Effects

Dapagliflozin and Metformin, called Xigduo XR for many patients, affects the way the body uses the glucose found in the bloodstream. By doing, so it can also affect other areas of health than just the regulation of blood sugar that it was meant for. These are the unwanted effects of the drug that you should notify your health care provider about, should you experience them:

  • Pain in your bladder
  • Urine showing blood or appearing cloudy
  • Vaginal discharge changes in amount, odor or color
  • Urination is painful, difficult or has a sensation of burning
  • Urgent, frequent urination
  • Pain in side or lower back
  • Stomach or abdominal discomfort
  • Appetite decreases
  • Diarrhea
  • Shallow, rapid breathing
  • Discomfort in general
  • Swollen hives on eyelids, sex organs, feet, legs, hands, lips, throat or tongue
  • Cramps in muscles or muscle pain
  • Nausea
  • Gasping for breath
  • Fatigue, weak muscles
  • Anxiety
  • Blurry vision
  • Cold sweats
  • Chills
  • Confusion
  • Coma
  • Pale skin that feels cool
  • Depression
  • Faintness, dizziness, lightheaded especially when rising from prone or seated positions
  • Rapid heartbeat
  • Headache
  • Fever
  • Itchy, rashy skin or hives
  • Hoarse voice
  • Hunger increased
  • Irritable
  • Stiff, swollen, painful joints
  • Nightmares
  • Skin redness
  • Shaking
  • Seizures
  • Speech that is slurred
  • Swollen face, eyes, lips, feet, or hands
  • Chest is tight
  • Swallowing is difficult

Though just as common as those previously listed, the following side effects of Dapagliflozin and Metformin therapy are typically mild and don't require medical attention unless they become severe or prolonged. If you have questions about any symptoms you have after starting treatment with Dapagliflozin and Metformin, don't hesitate to contact your physician immediately.

  • Sore throat
  • Nose is stuffed or runs
  • Pain in back area or body aches
  • Muscle soreness
  • Congestion
  • Constipation
  • Glands in neck are swollen or tender
  • Vocal changes

There may be other changes to your health after you start treatment with Dapagliflozin and Metformin. These changes should be discussed with your doctor or pharmacist to make sure no long term health implications will result.

Dosage

Dapagliflozin and Metformin is prescribed in a tablet form, to be taken completely and never chewed, crushed or broken as it will negate the extended release mechanism designed in the drug that provides a steady level of the medication and a more effective form of treatment. It is recommended that you take Dapagliflozin and Metformin with meals to ease any ill effects that may happen in the stomach. You may see part of the tablet pass in your stools, which is nothing to worry about.

Read and understand the leaflet included with your prescription and ask any questions you may have to the pharmacist or your medical doctor to make sure you understand fully how the drug will work in your system. Follow your medical plan for an exercise regime as well as the diet given to you by your doctor. Regular testing of your blood sugar levels should show a successful control of the level of glucose in your blood if you take this medicine as prescribed, eat right and exercise.

Different patients will be prescribed different size doses of this drug or may even be on a different schedule to allow a proper length of time between doses. The following is a general guideline on dosage, yours may differ and you should always follow what your doctor has specifically prescribed for you.

Extended release Dapagliflozin and Metformin tablets come in the following sizes:

  • Dapagliflozin/Metformin
  • 5 milligram/500 milligram
  • 5 milligram/1000 milligram
  • 10 milligram/500 milligram
  • 10 milligram/1000 milligram

Typically the starting dose for an adult patient is one tablet, once per day, to be taken in the morning. This dose may be adjusted per your body's requirements but does not typically exceed 10 milligrams of Dapagliflozin and 2000 milligram of Metformin in a 24 hour period. Use and dose of this medication in pediatric patients is determined for them specifically by their medical doctor.

Missing a dose of Dapagliflozin and Metformin is not recommended, but if you do and it is not close to the time for your next dose, take it as soon as you notice. If it is approaching time for your next dose, skip the dose you missed in favor of never doubling your dosage. Return to your regular dosing schedule as soon as possible.

Interactions

Dapagliflozin and Metformin are used in combination and have a common goal; regulation of blood glucose either by inhibition of absorption or by increasing the body's sensitivity to insulin. These drugs were meant to work together; however, not all drugs interact well with this medication and may cause severe health issues if taken together. Therefore, it is of utmost importance that any other prescription drugs or over-the-counter, vitamin, herbal or holistic drugs that you take be disclosed to your physician. If you are on the following prescription drugs, be aware that they are not recommended to be taken with Dapagliflozin and Metformin in any way:

  • Diatrizoate
  • Acetrizoic Acid
  • Iobenzamic Acid
  • Ethiodized Oil
  • Iocarmic Acid
  • Iobitridol
  • Iodamide
  • Iocetamic Acid
  • Iodixanol
  • Iodipamide
  • Iodopyracet
  • Iodohippuric Acid
  • Ioglicic Acid
  • Iodoxamic Acid
  • Iohexol
  • Ioglycamic Acid
  • Iopamidol
  • Iomeprol
  • Iopentol
  • Iopanoic Acid
  • Iopromide
  • Iophendylate
  • Ioseric Acid
  • Iopronic Acid
  • Iotasul
  • Iosimide
  • Iotrolan
  • Iothalamate
  • Ioversol
  • Iotroxic Acid
  • Ioxitalamic Acid
  • Ioxaglate
  • Metrizamide
  • Ipodate
  • Tyropanoate Sodium
  • Metrizoic Acid

Though not as severely warned against as the drugs in the previous list, the following drugs are also known to interact with Dapagliflozin and Metformin in ways that may reduce the effectiveness or cause health risks. Avoid the following drugs or notify your doctor before you start taking Dapagliflozin and Metformin if you currently take:

  • Aspirin
  • Besifloxacin
  • Balofloxacin
  • Ciprofloxacin
  • Bupropion
  • Dofetilide
  • Dasabuvir
  • Enoxacin
  • Dolutegravir
  • Flumequine
  • Fleroxacin
  • Gemifloxacin
  • Gatifloxacin
  • Levofloxacin
  • Lanreotide
  • Moxifloxacin
  • Lomefloxacin
  • Norfloxacin
  • Nadifloxacin
  • Ofloxacin
  • Octreotide
  • Paritaprevir
  • Ombitasvir
  • Pazufloxacin
  • Pasireotide
  • Prulifloxacin
  • Pefloxacin
  • Rufloxacin
  • Ritonavir
  • Thioctic Acid
  • Sparfloxacin
  • Vandetanib
  • Tosufloxacin

Finally, while the following drugs are known to interact in a negative way with Dapagliflozin and Metformin, taking them together may be necessary for your particular condition. Only your doctor can decide if you should be treated with Dapagliflozin and Metformin while on the following drugs:

  • Atenolol
  • Acebutolol
  • Bisoprolol
  • Betaxolol
  • Carteolol
  • Bitter Melon
  • Celiprolol
  • Carvedilol
  • Fenugreek
  • Esmolol
  • Glucomannan
  • Furazolidone
  • Iproniazid
  • Guar Gum
  • Labetalol
  • Isocarboxazid
  • Linezolid
  • Levobunolol
  • Metipranolol
  • Methylene Blue
  • Moclobemide
  • Metoprolol
  • Nebivolol
  • Nadolol
  • Oxprenolol
  • Nialamide
  • Penbutolol
  • Patiromer
  • Pindolol
  • Phenelzine
  • Procarbazine
  • Practolol
  • Psyllium
  • Propranolol
  • Rasagiline
  • Ranolazine
  • Safinamide
  • Rifampin
  • Sotalol
  • Selegiline
  • Tranylcypromine
  • Timolol

Some medications, including Dapagliflozin and Metformin, interact with certain foods or alcoholic beverages or even tobacco products. Consult your physician on food recommendations or advisement regarding consumption of tobacco or alcohol.

If you have been diagnosed or show symptoms of the following medical conditions, treatment with Dapagliflozin and Metformin may cause more harm than good or it may have a reduced effectiveness because of the way these conditions run your internal organs. Disclosing your full medical history to your health care provider prior to starting treatment with Dapagliflozin and Metformin is the best way to avoid any complications to the following health conditions:

  • Alcoholism, current or past
  • Shock or collapse
  • Underactive glands especially adrenal
  • Congestive heart failure
  • Severe dehydration
  • Heart attack
  • Deficiency in pancreatic insulin, current or past
  • Disease involving the pituitary gland
  • Malnourishment, current or past
  • Severe infections of any kind
  • Weak or poor physical condition
  • Low red blood cell count (anemic)
  • Cancer of the bladder, current or past
  • Dehydration
  • Genital yeast infections including vulvovaginitis, balanoposthitis or balanitis, current or past
  • Elevated blood cholesterol, hypercholesteremia
  • Reduced volume of blood, hypovolemia
  • Diseases involving the kidneys or urinary tract such as urosepsis or pyelonephritis, current or past
  • Deficiency of the B12 vitamin
  • Elevated ketones and/or acid in blood
  • Disease in the liver including metabolic acidosis
  • Dialysis patients
  • Type 1 Diabetes
  • Patients who have infection or fever
  • Patients who have had trauma or recent surgery

Warnings

Every medication, including Dapagliflozin and Metformin, has a risk associated with its use in treatment. If you have ever experienced and unusual reaction to any medication or supplement, avoid the same problem with this medication and let your physician know. Additionally, allergies to animals, preservatives dyes or foods should also be disclosed to the medical staff.

Pediatric patients have not been the subject of any data gathering on how effective Dapagliflozin and Metformin is or if there are increased risks using this medication with this age group. Similarly, geriatric patients have not been studied either, however it is more likely this age group also has diminished or diseased conditions involving the heart, liver or kidneys and, therefore, may require caution or dose adjustment before they can successfully be treated with Dapagliflozin and Metformin.

No studies exist that have provided data that confirms or denies risk to fetal health when Dapagliflozin and Metformin is prescribed to women or who pregnant or breastfeeding. Your physician is the best person to discuss any risks this medication poses to your unborn child's health if you take it while pregnant or breastfeeding.

Dapagliflozin and Metformin have been associated with a rare, serious unwanted effect known as lactic acidosis. This condition involves a high level of lactic acid that has built up in the blood, to the degree that it may be fatal. This condition can come on slowly and subtly, so all medical appointments should be kept in order to monitor the level of lactic acid in your blood. Seek immediate medical attention if you exhibit signs of lactic acidosis including:

  • Muscle pain
  • Uncomfortable, unwell feeling
  • Somnolence
  • Pain in the stomach or abdomen
  • Respiratory issues of any kind
  • Drowsiness

There is an elevated risk of lactic acidosis in patients who are elderly, those who are using certain drugs that interact negatively with Dapagliflozin and Metformin and patients who have had certain medical procedures, surgery and kidney function impairment.

Excessive alcohol consumption while being treated with Dapagliflozin and Metformin is warned against specifically, as this could also increase the chances of contracting lactic acidosis.

Patients with kidney functions that are impaired are more likely to experience a blood pressure that is too low while on treatment with Dapagliflozin and Metformin. This condition is known as hypotension and can dangerously affect the organs in the body such as the brain. Any unsteadiness, fainting or dizziness should be reported to your medical doctor immediately.

Ketoacidosis is a sometimes fatal, serious condition that can develop in patients being treated with Dapagliflozin and Metformin. Ketoacidosis is when the body does not have enough insulin, preventing the blood sugar from being consumed properly for energy purposes. Patients should be screened for this condition prior to being prescribed Dapagliflozin and Metformin and those taking the medication should report any symptoms such as nausea, pain in the abdominal area, vomiting, general unwell feeling and breath shortness.

It has been reported that those patients who already display impaired kidney function, had this condition worsened after taking Dapagliflozin and Metformin. Patients should be monitored frequently for acute kidney distress while on this medication.

Read and comprehend the information provided to you with this medication including all drug interactions and side effects. Ask any questions of your pharmacist or physician to make sure you understand all risks associated with taking Dapagliflozin and Metformin. Make sure you have disclosed your medical history and any current symptoms you are having as well as all medications, whether over the counter, vitamin or herbal prior to taking this drug therapy.

Storage

Store Dapagliflozin and Metformin and other medications out of sight and reach of children. Keep it in the original container at room temperature and do not allow it to come in contact with excessive heat, moisture or direct light. Do not allow Dapagliflozin and Metformin to freeze.

Any unused or expired doses of Dapagliflozin and Metformin should be disposed of following the safety instructions provided to you in the leaflet that comes with your prescription.

Summary

Dapagliflozin and Metformin is a drug therapy prescribed to patients suffering from type 2 diabetes, also called diabetes mellitus. This medication works in two ways to regulate the amount of blood sugar, used by an enzyme called insulin, to provide energy in the body. By regulating the blood sugar, Dapagliflozin and Metformin, combined with good nutrition and exercise, type 2 diabetes sufferers can experience a more normal life and reduce the risks associated with the disease on other parts of their body. Dapagliflozin and Metformin does not benefit type 1 diabetes sufferers and, in fact, should not be prescribed to them for safety reasons.

Dapagliflozin and Metformin cause mild side effects including nausea, congestion, sore throat, aches, pains, constipation and swollen neck glands, to name a few. These side effects may go away over time or prove to be mild. Other side effects could be warning signs of a possibly fatal underlying condition known as lactic acidosis. Patients who experience unusual weakness or fatigue, have trouble with breathing, are sleeping excessively or who are dizzy, lightheaded and have a slow, irregular heart rhythm should seek medical attention immediately. Dehydration can also occur in some patients as well as kidney damage and yeast infection in women. Report these symptoms to your health care provider immediately.

Dapagliflozin and Metformin is a combination drug therapy, two drugs that work together for a common goal. Other drugs, however, including those that are non-prescription or vitamin in nature, can interact with this medication. The list of these medications is long, so make sure you have disclosed to your doctor any information on all medications you take including supplements that are herbal or over the counter medications. Also include your medical history, as certain health conditions can cause an increased risk to your health while on this drug.

It is important to read and understand all information provided with your prescription, asking questions of your pharmacist or physician to make sure you comprehend all risks associated and effects of Dapagliflozin and Metformin medication. Follow the diet your doctor has prescribed for you and get plenty of exercise, as recommended for you. Diet and exercise have a profound influence in the way Dapagliflozin and Metformin can work to benefit your overall health condition.

Store this drug in the original container, at room temperature and out of sight and reach of children. Seek information on how to safely dispose of any unused or expired Dapagliflozin and Metformin. Follow your dosing schedule carefully, never double dosing this medication for any reason. Take the pills whole with food and do not break, crush or chew the tablets, which would negate the benefit of the time release formulation. Avoid excessive alcohol use during treatment with this drug and report any unusual health conditions immediately.

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Last Reviewed:
March 26, 2018
Last Updated:
April 12, 2018