Dapagliflozin and metformin (Oral)
Generic Name: dapagliflozin/metformin (dap-a-gli-FLOE-zin proe-pane-DYE-ol, met-FOR-min hye-droe-KLOR-ide)
Fatal metformin-associated lactic acidosis has been reported during postmarketing surveillance. The onset is often subtle and subtle and accompanied only by nonspecific symptoms (eg, malaise, myalgias, respiratory distress, somnolence, abdominal pain). Risk factors include concomitant carbonic anhydrase inhibitor use (eg, topiramate), age 65 or older, surgery and other procedures, radiological study with contrast, hypoxic states, excessive alcohol consumption, or hepatic impairment. If suspected, discontinue use and initiate hemodialysis and general supportive measures .
Medically reviewed by Drugs.com. Last updated on Sep 19, 2020.
Commonly used brand name(s)
In the U.S.
- Xigduo XR
Available Dosage Forms:
- Tablet, Extended Release
Therapeutic Class: Hypoglycemic
Pharmacologic Class: Dapagliflozin
Chemical Class: Metformin
Uses for dapagliflozin and metformin
Dapagliflozin and metformin combination is used together with proper diet and exercise to treat type 2 diabetes. It is also used to lower the risk of hospitalization for heart failure in patients with type 2 diabetes and heart or blood vessel disease.
Dapagliflozin works in the kidneys to prevent absorption of glucose (blood sugar). This helps lower the blood sugar level. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. It does not help patients who have insulin-dependent or type 1 diabetes. Type 1 diabetic patients must use insulin injections.
Dapagliflozin and metformin is available only with your doctor's prescription.
Before using dapagliflozin and metformin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For dapagliflozin and metformin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to dapagliflozin and metformin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of dapagliflozin and metformin combination in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of dapagliflozin and metformin combination in the elderly. However, elderly patients are more likely to have kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving dapagliflozin and metformin combination.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking dapagliflozin and metformin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using dapagliflozin and metformin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Acetrizoic Acid
- Ethiodized Oil
- Iobenzamic Acid
- Iocarmic Acid
- Iocetamic Acid
- Iodohippuric Acid
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iopanoic Acid
- Iopronic Acid
- Ioseric Acid
- Iotroxic Acid
- Ioxitalamic Acid
- Metrizoic Acid
- Tyropanoate Sodium
Using dapagliflozin and metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Thioctic Acid
Using dapagliflozin and metformin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bitter Melon
- Guar Gum
- Methylene Blue
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other medical problems
The presence of other medical problems may affect the use of dapagliflozin and metformin. Make sure you tell your doctor if you have any other medical problems, especially:
- Adrenal gland problem, underactive or
- Alcohol abuse, history of or
- Cardiovascular collapse (shock) or
- Congestive heart failure or
- Dehydration, severe or
- Heart attack, acute or
- Heart failure, history of or
- Hypovolemia (low blood volume) or
- Liver disease, history of or
- Pancreatic insulin deficiency, history of or
- Pituitary gland problem, underactive or
- Poorly nourished condition or
- Sepsis (severe infection) or
- Weakened physical condition—Use with caution. May cause side effects to become worse.
- Anemia (low red blood cells) or
- Dehydration or
- Genital yeast (fungus) infection (eg, balanitis, balanoposthitis, vulvovaginitis), history of or
- Hypotension (low blood pressure) or
- Kidney disease or
- Urinary tract infections (eg, pyelonephritis, urosepsis), history of or
- Vitamin B12 deficiency—Use with caution. May make these conditions worse.
- Diabetic ketoacidosis (high ketones and acid in the blood) or
- Kidney disease, severe or
- Metabolic acidosis (acid in the blood) or
- Patients receiving dialysis or
- Type I diabetes—Should not be used in patients with these conditions.
- Fever or
- Infection or
- Surgery or
- Trauma—Use with caution. These conditions may cause problems with blood sugar control.
- Hypoxia (low oxygen in the blood) or
- Kidney damage or
- Liver damage or
- Radiologic procedures (eg, X-rays, CT scans, MRIs) that require dyes to be injected into your vein—May increase your risk for lactic acidosis (too much acid in the blood).
Proper use of dapagliflozin and metformin
Take dapagliflozin and metformin only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Do not change your dose unless directed by your doctor.
Dapagliflozin and metformin should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
Swallow the extended-release tablet whole. Do not crush, break, or chew it.
While taking the extended-release tablet, part of it may pass into your stools. This is normal and is nothing to worry about.
Carefully follow the special meal plan your doctor gave you. This is the most important part of controlling your diabetes, and will help the medicine work properly. Exercise regularly and test for sugar in your blood or urine as directed.
Tell your doctor if you are on a low-salt or sodium diet.
The dose of dapagliflozin and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of dapagliflozin and metformin. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (extended-release tablets):
- For type 2 diabetes:
- Adults—At first, 5 milligrams (mg) once a day in the morning with food. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than dapagliflozin 10 mg and metformin 2000 mg per day.
- Children—Use and dose must be determined by your doctor.
- To lower risk of hospitalization for heart failure:
- Adults—10 milligrams (mg) once a day in the morning.
- Children—Use and dose must be determined by your doctor.
- For type 2 diabetes:
If you miss a dose of dapagliflozin and metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using dapagliflozin and metformin
It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take dapagliflozin and metformin. Blood and urine tests may be needed to check for unwanted effects.
Serious allergic reactions may occur with dapagliflozin and metformin. Check with your doctor right away if you have a skin rash, hives or welts, itching, redness of the skin, trouble breathing, or large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals.
Using dapagliflozin and metformin during the second and third part of your pregnancy can harm your unborn baby. If you think you have become pregnant while using dapagliflozin and metformin, tell your doctor right away.
Dapagliflozin and metformin may cause some women who do not have regular monthly periods to ovulate. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.
It is very important to follow carefully any instructions from your doctor about:
- Alcohol—Drinking alcohol may cause severe low blood sugar and increase risk for lactic acidosis. Discuss this with your doctor.
- Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
- Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.
- Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
- In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
Under certain conditions, too much metformin can cause a serious condition called lactic acidosis. The symptoms of lactic acidosis are severe and appear quickly. Lactic acidosis usually occurs when other serious health problems are present, such as a heart attack or kidney failure. The symptoms of lactic acidosis include: abdominal or stomach discomfort, decreased appetite, diarrhea, fast or shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness. If you have more than one of these symptoms together, you should get immediate emergency medical help.
Dizziness, lightheadedness, or fainting may occur with dapagliflozin and metformin. This is more common if you have kidney disease, low blood pressure, or if you are taking a diuretic (water pill). Taking plenty of fluids each day may help. Drink plenty of water during exercise or in hot weather. Check with your doctor if you have severe nausea, vomiting, or diarrhea that does not stop. This may cause you to lose too much water.
Ketoacidosis (high ketones and acid in the blood) may occur while you are using dapagliflozin and metformin. This can be life-threatening and requires immediate medical attention. Your doctor may give you insulin, fluid, and carbohydrate replacement to treat this condition. Tell your doctor right away if you have nausea, vomiting, trouble breathing, increased thirst or urination.
Tell your doctor if you have bloody urine, decrease in how much or how often you urinate, painful or difficult urination, lower back or side pain, fever, chills, or swelling of the face, finger, or lower legs. These may be symptoms of a serious kidney problem.
Let your doctor or dentist know you are using dapagliflozin and metformin. Your doctor may advise you to stop using dapagliflozin and metformin at least 3 days before you have major surgery or diagnostic tests, especially tests that use a contrast dye.
Dapagliflozin and metformin may cause vaginal yeast infections in women and yeast infections of the penis in men. This is more common in patients who have a history of genital yeast infections or in men who are not circumcised. Women may have a vaginal discharge, itching, or odor. Men may have redness, itching, swelling, or pain around the penis, or a discharge with a strong odor from the penis. Check with your doctor right away if you have any of these symptoms.
Dapagliflozin and metformin may increase risk of having urinary tract infections, including pyelonephritis or urosepsis. Check with your doctor right away if you have bladder pain, bloody or cloudy urine, difficult, burning, or painful urination, or lower back or side pain.
Dapagliflozin and metformin may cause a rare but serious bacterial infection, called necrotizing fasciitis of the perineum or Fournier's gangrene, which can cause damage to the tissue under the skin in the area between and around the anus and genitals (perineum). Fournier's gangrene may lead to hospitalization, multiple surgeries, or death. Check with your doctor right away if you have fever, unusual tiredness or weakness, or pain, tenderness, redness, or swelling of the area between and around your anus and genitals.
Dapagliflozin and metformin may cause hypoglycemia (low blood sugar). This is more common when dapagliflozin and metformin is taken together with other diabetes medicines (eg, insulin, glipizide, glyburide). The symptoms of low blood sugar must be treated before they cause you to pass out. People feel different symptoms with low blood sugar. It is important that you learn which symptoms you usually have so you can treat it quickly. Some symptoms of low blood sugar include: behavior changes that are similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, a fast heartbeat, headaches that continue, nausea, shakiness, slurred speech, or unusual tiredness or weakness. Talk to your doctor about how to treat low blood sugar.
Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your diabetes medicine, overeat or do not follow your diet plan, have a fever or infection, or do not exercise as much as usual. Some symptoms of high blood sugar include: blurred vision, drowsiness, dry mouth, flushed and dry skin, fruit-like breath odor, increased frequency and amount of urination, ketones in the urine, loss of appetite, nausea or vomiting, rapid and deep breathing, tiredness, or unusual thirst. If symptoms of high blood sugar occur, check your blood sugar level and call your doctor for instructions.
Dapagliflozin and metformin side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
- Bladder pain
- bloody or cloudy urine
- change in the color, amount, or odor of vaginal discharge
- difficult, burning, or painful urination
- frequent urge to urinate
- lower back or side pain
- Decreased appetite
- fast, shallow breathing
- general feeling of discomfort
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
- muscle pain or cramping
- stomach discomfort
- unusual tiredness or weakness
Incidence not known
- blurred vision
- clay-colored stools
- cold sweats
- cool, pale skin
- dark urine
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- fast heartbeat
- hives, itching, or rash
- increased hunger
- joint pain, stiffness, or swelling
- loss of appetite
- loss of consciousness
- pain, tenderness, redness, or swelling of the area between the anus and genitals
- redness of the skin
- slurred speech
- swelling of the eyelids, face, lips, hands, or feet
- tightness in the chest
- troubled swallowing
- unpleasant breath odor
- vomiting of blood
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Muscle aches
- sore throat
- stuffy or runny nose
- Back pain
- body aches or pain
- difficulty having a bowel movement
- tender, swollen glands in the neck
- voice changes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Frequently asked questions
More about dapagliflozin / metformin
- Side Effects
- During Pregnancy
- Dosage Information
- Drug Interactions
- En Español
- 10 Reviews
- Drug class: antidiabetic combinations
- FDA Alerts (4)
- Other brands
- Xigduo XR
Related treatment guides
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.