Dapagliflozin / Metformin Side Effects

Medically reviewed by Drugs.com. Last updated on Oct 8, 2023.

Applies to dapagliflozin / metformin: oral tablet extended release.

Important warnings This medicine can cause some serious health issues

Oral route (tablet, extended release)

Lactic Acidosis. Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias.

The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain.

Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (greater than 5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally greater than 5 mcg/mL.Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (eg, carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (eg, acute congestive heart failure), excessive alcohol intake, and hepatic impairment.Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the full prescribing information.If metformin-associated lactic acidosis is suspected, immediately discontinue dapagliflozin/metformin hydrochloride and institute general supportive measures in a hospital setting.

Prompt hemodialysis is recommended.

Serious side effects

Along with its needed effects, dapagliflozin / metformin 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 while taking dapagliflozin / metformin:

More common side effects

• 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

Rare side effects

• decreased appetite
• diarrhea
• 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
• nausea
• sleepiness
• stomach discomfort
• unusual tiredness or weakness

Incidence not known

• anxiety
• blurred vision
• chest tightness
• chills
• clay-colored stools
• cold sweats
• confusion
• cool, pale skin
• dark urine
• depression
• dizziness
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fast heartbeat
• fever
• headache
• hives, itching, or rash
• hoarseness
• increased hunger
• irritation
• joint pain, stiffness, or swelling
• loss of appetite
• loss of consciousness
• nightmares
• pain, tenderness, redness, or swelling of the area between the anus and genitals
• redness of the skin
• seizures
• shakiness
• slurred speech
• sweating
• swelling of the eyelids, face, lips, hands, or feet
• trouble swallowing
• unpleasant breath odor
• vomiting of blood
• yellow eyes or skin

Other side effects

Some side effects of dapagliflozin / metformin 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:

More common side effects

• muscle aches
• sore throat
• stuffy or runny nose

Less common side effects

• back pain
• body aches or pain
• difficulty having a bowel movement
• tender, swollen glands in the neck
• voice changes

For healthcare professionals

Applies to dapagliflozin / metformin: oral tablet extended release.

General adverse events

The most common adverse reactions reported with this combination drug included female genital mycotic infection, nasopharyngitis, urinary tract infection, diarrhea, and headache.^[Ref]

Cardiovascular

• Uncommon (0.1% to 1%): Volume depletion (Including dehydration, hypovolemia, orthostatic hypotension, or hypotension)^[Ref]

Dermatologic

Dapagliflozin:

• Postmarketing reports: Rash

Metformin:

• Uncommon (0.1% to 1%): Angioedema
• Very rare (less than 0.01%): Urticaria, erythema, pruritus^[Ref]

Endocrine

Dapagliflozin:

• Frequency not reported: Small Increase in serum parathyroid hormone levels^[Ref]

Small increases in serum parathyroid hormone (PTH) levels were observed with increases larger in subjects with higher baseline PTH concentrations.^[Ref]

Gastrointestinal

Dapagliflozin-Metformin:

• Common (1% to 10%): Diarrhea, nausea, constipation

Dapagliflozin:

• Uncommon (0.1% to 1%): Constipation, dry mouth

Metformin:

• Very common (10% or more): Nausea, vomiting, diarrhea, abdominal pain, loss of appetite^[Ref]

Genitourinary

• Common (1% to 10%): Escherichia urinary tract infection, female genital mycotic infections (including vulvovaginal mycotic infection, vaginal infection, genital infection, vulvovaginitis, fungal genital infection, vulvovaginal candidiasis, vulval abscess, vulvitis, genital candidiasis, and vaginitis bacterial), urinary tract infections (including urinary tract infection, cystitis, pyelonephritis, urethritis, and prostatitis), male genital mycotic infections (including balanitis, fungal genital infection, penile infection, trigonitis, balanitis candida, genital candidiasis, balanoposthitis, balanoposthitis infective, genital infection, posthitis), nocturia (including pollakiuria, polyuria, and increased urine output), discomfort with urination
• Uncommon (0.1% to 1%): Vulvovaginal pruritus
• Postmarketing reports: Fournier's gangrene, urosepsis, pyelonephritis^[Ref]

Genital mycotic infections have been commonly reported with dapagliflozin treatment. Discontinuation due to genital infection occurred in 0.2% of patients in dapagliflozin clinical trials. Infections were more frequently reported in females than males, and patients with a history of genital mycotic infections were more likely to have an infection than those without a history.

In the 5 years (2013 to 2018) since SGLT2 inhibitor approval, 12 cases of Fournier's gangrene have been reported. Reports were almost equal in adults (men=7; women=5), ages ranged from 38 to 78 years, and the average time to onset after starting an SGLT2 inhibitor was 9.2 months (range 7 days to 25 months).^[Ref]

Hematologic

Dapagliflozin:

• Common (1% to 10): Increased hematocrit

Metformin:

• Very rare (less than 0.01%): Decreased vitamin B12 serum levels^[Ref]

Hepatic

Metformin:

• Very rare (less than 0.01%): Liver function disorders, liver function tests abnormalities, hepatitis
• Postmarketing reports: Cholestatic, hepatocellular, mixed hepatocellular liver injury^[Ref]

Hypersensitivity

Dapagliflozin:

• Uncommon (0.1% to 1%): Serious anaphylactic reactions, severe cutaneous reactions
• Frequency not reported: Hypersensitivity reactions (included urticaria, hypersensitivity)^[Ref]

Immunologic

• Common (1% to 10): Influenza^[Ref]

Metabolic

Dapagliflozin-Metformin:

• Very common (10% or more): Hypoglycemia (when used with sulfonylurea or insulin)
• Common (1% to 10%): Dyslipidemia

Dapagliflozin:

• Common (1% to 10%): Hyperphosphatemia, increases in low-density lipoprotein cholesterol (LDL-C)
• Uncommon (0.1% to 1%): Decreased weight, thirst
• Postmarketing reports: Acidosis including diabetic ketoacidosis, ketoacidosis, or ketosis

Metformin:

• Very rare (less than 0.01%): Lactic acidosis, vitamin B12 deficiency^[Ref]

Hypoglycemia was reported more frequently when this drug was added to sulfonylurea or insulin (up to 43%).

Twenty reports of acidosis have been identified in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database during the period March 2013 through 06 June 2014. All patients required emergency room treatment or hospitalization. These cases were not typical of ketoacidosis or diabetic ketoacidosis (DKA) in that they occurred in patients with type 2 diabetes and their blood sugar levels were only slightly increased. Some factors identified as potentially triggering the acidosis included major illness, reduced food and fluid intake, and reduced insulin dose.^[Ref]

Musculoskeletal

Dapagliflozin-Metformin:

• Common (1% to 10%): Back pain

Dapagliflozin:

• Common (1% to 10%): Pain in extremity^[Ref]

Nervous system

Dapagliflozin-Metformin:

• Common (1% to 10%): Headache, dizziness

Metformin:

• Common (1% to 10%): Taste disturbance^[Ref]

Oncologic

Dapagliflozin:

• Uncommon (0.1% to 1%): Bladder cancer^[Ref]

Newly diagnosed bladder cancer was reported in 10 of 6045 (0.17%) patients receiving dapagliflozin in clinical trials.^[Ref]

Other

• Uncommon (0.1% to 1%): Fungal infection

Renal

Dapagliflozin:

• Uncommon (0.1% to 1%): Increased serum creatinine, increased blood urea
• Frequency not reported: Decreases in eGFR, kidney infection
• Postmarketing reports: Acute kidney injury and impaired renal function^[Ref]

Cases of acute kidney injury have been reported during the postmarketing period with dapagliflozin. Some cases required hospitalization and dialysis; some reports were in patients less than 65 years old.^[Ref]

Respiratory

• Common (1% to 10%): Nasopharyngitis, cough, pharyngitis^[Ref]

Frequently asked questions

• What are the ingredient drugs contained in Qternmet XR?

Further information

Dapagliflozin/metformin side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer