Xigduo (dapagliflozin, metformin)

Xigduo tablets contain a combination of 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.

Garvan

Pharmacist - M.B.A. (Public Health) D.I.C.

Xigduo (dapagliflozin, metformin)

What is Xigduo used for? Type 2 diabetes in…

Garvan J. Lynch
Supervising Pharmacist

MBA (Public Health)

What is Xigduo used for?

  • Type 2 diabetes in adults aged 18 years and over.
  • Xigduo tablets are licensed for use in people with type 2 diabetes whose blood sugar is not controlled by the maximum tolerated dose of metformin alone or who are already taking metformin and dapagliflozin as separate tablets.
  • Xigduo tablets can also be used for people with type 2 diabetes whose blood sugar is not sufficiently controlled by other antidiabetic medicines. It can be added to treatment with a sulphonylurea such as gliclazide or glibenclamide, or to treatment with insulin.

How does Xigduo work?

  • In type 2 diabetes the cells in the body become resistant to the action of insulin. Insulin is the main hormone responsible for controlling the level of sugar (glucose) in the blood. It makes cells in the body remove sugar from the blood. When the cells are resistant to insulin this makes blood sugar levels rise too high.
  • Metformin is a type of antidiabetic medicine known as a biguanide. It works in a number of ways to decrease the amount of sugar in the blood. Firstly, it reduces the amount of sugar produced by cells in the liver. Secondly, it increases the sensitivity of muscle cells to insulin. This enables these cells to remove sugar from the blood more effectively. Finally, it delays absorption of sugar from the intestines into the bloodstream after eatingso that there is less of a spike in blood sugar levels after meals.
  • Dapagliflozin works in the kidneys, where it allows the body to excrete excess glucose from the blood into the urine.
  • Normally, when the kidneys filter and clean the blood, glucose is filtered out of the blood at the same time. The glucose is then reabsorbed back into the blood by a mechanism called the sodium-glucose co-transporter 2 (SGLT2). The kidneys normally reabsorb glucose back into the blood even when the levels of glucose in the blood are too high, as in diabetes.
  • Dapagliflozin works by inhibiting the SGLT2 transporter. This allows excess glucose to be filtered out of the blood and excreted in the urine. This will reduce blood sugar levels.
  • Dapagliflozin has two other effects that may be of benefit for people with diabetes. Firstly, it may cause weight loss due to the loss of sugar from the body. Secondly, it causes a small increase in the amount of water being filtered out of the blood into the urine (diuresis). This may help to reduce blood pressure.

How do I take Xigduo?

  • One Xigduo tablet should be taken twice a day (with breakfast and evening meal) on a regular basis. The tablet should be taken with food.
  • If you forget to take your Xigduo tablet at your usual time, take it with food as soon as you remember. However, if it is nearly time for your next dose, leave out the forgotten dose. Do not take a double dose to make up for a missed dose.

What should I know before taking Xigduo?

  • It is important that you continue to follow the diet and exercise advice given to you by your doctor or nurse while you are taking Xigduo. This medicine only helps to control your blood sugar levels and should not be used as a substitute for eating healthily and taking regular exercise.

Who should not take Xigduo?

  • People with type 1 diabetes.
  • People with diabetic ketoacidosis.
  • People taking the medicine pioglitazone for diabetes.
  • People with decreased kidney function or kidney failure.
  • People with liver problems.
  • People who are dehydrated.
  • People with severe infections or blood poisoning (sepsis).
  • People with reduced blood flow to vital internal organs (shock).
  • People with conditions that cause breathing to be ineffective, ie to not effectively oxygenate the blood or remove carbon dioxide from the lungs (respiratory failure).
  • People with acute heart failure or who have recently had a heart attack.
  • People who drink large amounts of alcohol or are suffering from alcoholism.
  • Women who are pregnant or breastfeeding.
  • People who are allergic to any ingredient of the medicine.
  • Xigduo is not recommended for people taking loop diuretics, eg furosemide.
  • Xigduo is not recommended for people with low fluid volume or salt levels in the body, eg due to diuretic therapy, low-sodium diet, diarrhoea or vomiting.
  • Xigduo is not recommended for people over 75 years of age, or for children and adolescents under 18 years of age, because it has not been studied in these age groups.

Xigduo should be used with caution by

  • Elderly people.
  • People taking medicines for high blood pressure who have a history of low blood pressure.
  • People with heart disease.
  • People with a high percentage of red blood cells in their blood (high haematocrit).
  • People with a history of frequent urinary tract infections.
  • People with a history of frequent genital infections such as thrush.

Can I take Xigduo while pregnant or breastfeeding?

  • The safety of dapagliflozin for use during pregnancy has not been established and for this reason Xigduo should not be used during pregnancy. Diabetes mellitus is usually controlled using insulin during pregnancy, because this provides a more stable control of blood sugar. If you get pregnant while taking this medicine, or are planning a pregnancy, you should seek medical advice from your doctor.
  • It is not known if dapagliflozin passes into breast milk. For this reason the manufacturer states that Xigduo should not be used by breastfeeding mothers. Seek medical advice from your doctor.

Side effects of Xigduo?

Very common 

  • Low blood sugar levels (when used with a sulphonylurea such as glibenclamide, or with insulin - see what should I know above).
  • Disturbances of the gut such as nausea, vomiting, diarrhoea.
  • Loss of appetite.

Common 

  • Vaginal thrush.
  • Inflammation of the penis and/or foreskin due to thrush infection (candidal balanitis).
  • Urinary tract infections.
  • Difficulty or pain passing urine (dysuria).
  • Increased production of urine (polyuria).
  • Back pain.
  • Dizziness.
  • Increased percentage of red blood cells in the blood (increased haematocrit).
  • Changes in the levels of cholesterol and other fats in the blood.
  • Taste disturbance, usually a metallic taste.

Uncommon 

  • Vaginal changes such as itching, abnormal discharge or odour.
  • Dehydration. Consult a doctor straight away if you experience symptoms of this, such as excessive thirst, a very dry or sticky mouth, sleepiness, a fast heartbeat, or passing little or no urine.
  • Low blood pressure.
  • Constipation.
  • Excessive sweating.
  • Needing to pass urine at night (nocturia).
  • Increased creatinine and urea (markers of kidney function) in the blood.
  • Weight loss.

If you want any more information about the possible side effects of Xigduo you should talk to your doctor or pharmacist, or read the leaflet that comes with the medicine. 

Can I take other medicines with Xigduo?

  • Xigduo should not be used in combination with pioglitazone.
  • Dapagliflozin may enhance the effect of diuretic medicines such as furosemide or bendroflumethiazide, which help to remove water from the body. If you are taking Xigduo with a diuretic your doctor may need to change the dose of the diuretic medicine to make sure that you do not lose too much fluid.

There may be an increased risk of developing lactic acidosis if you take medicines that can affect your kidney function with metformin. These include the following:

  • diuretic medicines such as furosemide
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.

If you are prescribed any of the following medicines with Xigduo you may be more likely to get low blood sugar (hypoglycaemia), so your doctor may want you to monitor your blood sugar levels more frequently if you start treatment with one of these:

  • ACE inhibitors such as captopril
  • disopyramide
  • MAOI antidepressants, such as phenelzine, tranylcypromine or isocarboxazid
  • other antidiabetic medicines, such as sulphonylureas (eg gliclazide, glibenclamide) or insulin.

Medicines that increase blood sugar levels as a side effect may make Xigduo less effective at controlling blood sugar. Medicines that can increase blood sugar levels include the following:

  • antipsychotic medicines, such as chlorpromazine, olanzapine, risperidone
  • beta-2-agonists, such as salbutamol, salmeterol
  • corticosteroids, such as prednisolone
  • glucosamine
  • oestrogens and progestogens, such as those found in oral contraceptives or HRT
  • diuretics, such as bendroflumethiazide or furosemide.

Octreotide and lanreotide may also affect blood sugar levels. If you are being treated with one of these medicines your doctor may want to check your blood sugar levels and adjust your metformin dose if necessary.

The following medicines may increase the blood level of metformin, which could increase the risk of its side effects. Your doctor may need to reduce your metformin dose if you regularly take one of these:

  • cimetidine
  • dolutegravir
  • rilpivirine
  • telaprevir
  • topiramate
  • vandetanib.

A drop in the number of blood cells called platelets in the blood has been seen in some people taking the antihistamine ketotifen in combination with metformin. The manufacturer of ketotifen recommends that it should be avoided in people taking metformin.

References:

https://www.drugs.com/xigduo-xr.html

https://www.netdoctor.co.uk/medicines/diabetic/a8904/xigduo-dapagliflozin-metformin/

https://www.medicines.org.uk/emc/product/7612/pil#gref

https://www.xigduoxr.com

https://www.xigduoxr.com/combination-medication/what-you-should-know.html

https://www.webmd.com/drugs/2/drug-167199/xigduo-xr-oral/details

https://www.medbroadcast.com/drug/getdrug/xigduo

https://www.rxlist.com/xigduo-xr-side-effects-drug-center.htm

 

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