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dapagliflozin and metformin

Generic Name: dapagliflozin and metformin (DAP a gli FLOE zin and met FOR min)
Brand Name: Xigduo XR

What is dapagliflozin and metformin?

Dapagliflozin and metformin are oral diabetes medicines that help control blood sugar levels. Dapagliflozin works by helping the kidneys get rid of glucose from your bloodstream. Metformin lowers glucose production in the liver and also causes your intestines to absorb less glucose.

Dapagliflozin and metformin is a combination medicine used together with diet and exercise to treat type 2 diabetes. Dapagliflozin is not for treating type 1 diabetes.

Dapagliflozin and metformin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about dapagliflozin and metformin?

You should not use this medicine if you have severe kidney disease, or diabetic ketoacidosis. Dapagliflozin and metformin is not for treating type 1 diabetes.

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking dapagliflozin and metformin.

This medicine may cause a serious condition called lactic acidosis. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

What should I discuss with my healthcare provider before taking dapagliflozin and metformin?

You should not use this medicine if you are allergic to dapagliflozin (Farxiga) or metformin (Glucophage, Actoplus Met, Avandamet, Fortamet, Glucovance, Janumet, Jentadueto, Kazano, Kombiglyze, Metaglip, PrandiMet, Riomet), or if you have:

  • moderate to severe kidney disease (or if you are on dialysis); or

  • diabetic ketoacidosis (call your doctor for treatment with insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking dapagliflozin and metformin.

Some people taking metformin develop a serious condition called lactic acidosis. This may be more likely if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your risk.

To make sure dapagliflozin and metformin is safe for you, tell your doctor if you have:

  • liver disease;

  • low blood pressure;

  • a history of bladder cancer;

  • high cholesterol levels;

  • a history of heart attack or stroke;

  • if you are on a low salt diet;

  • if you take blood pressure medicine; or

  • if you are 80 or older and your kidneys have not been tested.

It is not known whether dapagliflozin and metformin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether dapagliflozin and metformin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Dapagliflozin and metformin is not approved for use by anyone younger than 18 years old.

How should I take dapagliflozin and metformin?

Your doctor may perform kidney function tests before you start taking dapagliflozin and metformin.

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take with food to prevent an upset stomach.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

If you need to fast (stop eating) before a surgery, tell the surgeon ahead of time that you take dapagliflozin and metformin. You may need to stop using the medicine for a short time.

You may have very low blood pressure while taking this medicine. Call your doctor if you are sick with vomiting or diarrhea, if you consume less food or fluid than usual, or if you are sweating more than usual.

Your doctor may have you take extra vitamin B12 while you are taking dapagliflozin and metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

Dapagliflozin and metformin can cause positive results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using dapagliflozin.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Dapagliflozin and metformin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store at room temperature, away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of metformin may cause lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid while taking dapagliflozin and metformin?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking this medicine.

Dapagliflozin and metformin side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Early symptoms of lactic acidosis may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • dehydration symptoms--feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;

  • ketoacidosis (too much acid in the blood)--nausea, vomiting, stomach pain, confusion, unusual drowsiness, or trouble breathing;

  • signs of a kidney problem--little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath;

  • signs of a bladder infection--pain or burning when you urinate, urine that looks cloudy, pain in pelvis or back; or

  • signs of a genital infection (penis or vagina)--pain, burning, itching, rash, redness, odor, or discharge.

Side effects may be more likely to occur in older adults.

Common side effects may include:

  • bladder infection or genital infection;

  • headache;

  • nausea, vomiting, diarrhea; or

  • cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Dapagliflozin and metformin dosing information

Usual Adult Dose for Diabetes Type 2:

Individualize dose based on current treatment regimen:
Maintenance dose: Take orally once a day; titrate gradually based on effectiveness and tolerability
Maximum dose: Dapagliflozin 10 mg-metformin 2000 mg per day

Comments:
-Patients taking an evening dose of metformin XR should skip their last dose before starting this drug; take this drug once daily in the morning with food.
-When used in combination with insulin or insulin secretagogue, a lower dose of with insulin or insulin secretagogue may be considered to reduce the risk of hypoglycemia.

Use: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both dapagliflozin and metformin is appropriate.

What other drugs will affect dapagliflozin and metformin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with dapagliflozin and metformin, especially:

  • digoxin (digitalis, Lanoxin);

  • a diuretic or "water pill";

  • insulin or other oral diabetes medications;

  • rifampin;

  • ritonavir; or

  • seizure medicine--phenobarbital, phenytoin.

This list is not complete. Other drugs may interact with dapagliflozin and metformin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about dapagliflozin and metformin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.04.

Date modified: November 30, 2016
Last reviewed: July 13, 2016

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