Dapagliflozin Metformin Brand Name– Xigduo XR
What is Dapagliflozin Metformin
Dapagliflozin metformin is a combination product containing 2 oral antidiabetic agents.
Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor and metformin is a biguanide agent that improves insulin sensitivity. The combination product is used to improve glycemic control in adults with type 2 diabetes mellitus (DM).
When dapagliflozin is added to a metformin regimen, the combination results in a further mean hemoglobin A1C reduction of 0.7% to 0.8%, which may help patients achieve target A1C goals.
Dapagliflozin is also used to reduce the risk of hospitalization for heart failure (HF) in adults with type 2 DM and established cardiovascular (CV) disease or multiple CV risk factors.
Dapagliflozin was superior to placebo in reducing the incidence of the primary composite endpoint of hospitalization for heart failure or CV death (HR 0.83 [95% CI 0.73, 0.95]), which reflected a lower rate of hospitalization for heart failure in subjects randomized to dapagliflozin (HR 0.73 [95% CI 0.61, 0.88]), with no change in the risk of CV death.
As with other SGLT2 inhibitor/metformin combinations, products containing dapagliflozin; metformin should not be used in patients with severe renal impairment as dapagliflozin efficacy is reduced and the risk of metformin-related lactic acidosis is increased.
Metformin is first-line in the treatment of type 2 DM. Additional therapy with an SGLT2 inhibitor with evidence of reducing HF and/or chronic kidney disease (CKD) progression should be considered in patients with indicators of high-risk or established CKD or HF, independent of baseline A1C or individualized A1C target. SGLT2 inhibitors with proven CV-risk reduction, like dapagliflozin, are also an alternative treatment option in DM patients with indicators of high-risk or established CV disease who cannot tolerate a glucagon-like peptide-1 receptor agonist (GLP-1 RA)
Indications
- reduction of heart failure hospitalizations
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus in combination with diet and exercise; dapagliflozin is also used for reduction of heart failure hospitalizations in adults with T2DM and established cardiovascular (CV) disease or multiple CV risk factors
Side Effects
- abdominal pain
- anaphylactoid reactions
- angioedema
- anorexia
- back pain
- balanitis
- bone fractures
- candidiasis
- chest pain (unspecified)
- chills
- cholestasis
- constipation
- cough
- cystitis
- dehydration
- diabetic ketoacidosis
- diarrhea
- diuresis
- dizziness
- dysgeusia
- dyspepsia
- elevated hepatic enzymes
- flatulence
- flushing
- folate deficiency
- headache
- hepatitis
- hypercholesterolemia
- hyperhidrosis
- hyperlipidemia
- hyperphosphatemia
- hypoglycemia
- hypotension
- hypovolemia
- increased urinary frequency
- infection
- influenza
- lactic acidosis
- malaise
- megaloblastic anemia
- metabolic acidosis
- metallic taste
- myalgia
- nausea
- necrotizing fasciitis
- orthostatic hypotension
- palpitations
- pharyngitis
- polyuria
- prostatitis
- rash
- renal failure (unspecified)
- rhabdomyolysis
- tissue necrosis
- urticaria
- vaginitis
- vitamin B12 deficiency
- vomiting
Monitoring Parameters
- blood glucose
- CBC
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- serum cholesterol profile
- serum creatinine/BUN
Contraindications
- acidemia
- acute heart failure
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- balanitis
- breast-feeding
- burns
- cardiac disease
- cardiogenic shock
- children
- dehydration
- diabetic ketoacidosis
- dialysis
- diarrhea
- ethanol ingestion
- ethanol intoxication
- fever
- gastroparesis
- geriatric
- GI obstruction
- heart failure
- hepatic disease
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypotension
- hypothyroidism
- hypovolemia
- hypoxemia
- ileus
- infants
- infection
- laboratory test interference
- lactic acidosis
- malnutrition
- metabolic acidosis
- pernicious anemia
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- pyelonephritis
- radiographic contrast administration
- renal disease
- renal failure
- renal impairment
- sepsis
- surgery
- tissue necrosis
- trauma
- type 1 diabetes mellitus
- urinary tract infection (UTI)
- vaginitis
- vomiting
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