Indications for: XIGDUO XR
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Dapagliflozin: to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and established cardiovascular disease (CVD) or multiple cardiovascular (CV) risk factors. To reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure (NYHA class II-IV) with reduced ejection fraction.
Limitations of Use:
Not recommended in patients with type 1 diabetes; may increase risk of diabetic ketoacidosis. Due to the metformin component, the use of Xigduo XR is limited to adults with type 2 diabetes mellitus for all indications.
Swallow whole. Take once daily in the AM with food. Individualize. Glycemic control (not already on dapagliflozin): initiate with dapagliflozin 5mg. Heart failure related indications: dapagliflozin 10mg. Both: may adjust dose as tolerated; max 10mg/2000mg daily. Hepatic or renal impairment (eGFR <45mL/min/1.73m2): not recommended.
<18yrs: not established.
XIGDUO XR Contraindications:
Severe renal impairment (eGFR <30mL/min/1.73m2), ESRD, or on dialysis. Metabolic acidosis, diabetic ketoacidosis.
XIGDUO XR Warnings/Precautions:
Increased risk of metformin-associated lactic acidosis in renal or hepatic impairment, concomitant use of certain drugs (eg, cationic drugs), ≥65yrs of age, undergoing radiological contrast study, surgery and other procedures, hypoxic states, and excessive alcohol intake; discontinue if lactic acidosis occurs. Discontinue at time of, or prior to intravascular iodinated contrast imaging in patients with a history of hepatic impairment, alcoholism, heart failure, or will be given intra-arterial contrast; reevaluate eGFR 48hrs after procedure and restart therapy if renally stable. Assess renal function (esp. eGFR) prior to starting, then annually, or as clinically indicated; more frequently in elderly. Prior to initiation, assess and correct volume status in those with renal impairment, elderly, or taking loop diuretics; monitor during therapy. Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue if suspected, evaluate and treat; consider risk factors before initiation (eg, pancreatic insulin deficiency, caloric restriction, alcohol abuse). Consider temporarily discontinuing prior to scheduled surgery (for ≥3 days) or other clinical situations (eg, prolonged fasting due to illness or post-surgery). Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Monitor for genital mycotic infections, UTIs, hematology (esp. serum Vit. B12); treat if needed. Pregnancy (2nd & 3rd trimesters), nursing mothers: not recommended.
XIGDUO XR Classification:
Sodium-glucose co-transporter 2 (SGLT2) inhibitor + biguanide.
XIGDUO XR Interactions:
Increased risk of lactic acidosis with topiramate, other carbonic anhydrase inhibitors (eg, zonisamide, acetazolamide, dichlorphenamide); monitor. Concomitant cationic drugs that interfere with renal tubular transport systems (eg, ranolazine, vandetanib, dolutegravir, cimetidine) may increase metformin levels. Diuretics, steroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, CCBs, and isoniazid may cause hyperglycemia; monitor. Avoid excessive alcohol. May need a lower dose of concomitant insulin/insulin secretagogue to reduce risk of hypoglycemia. β-blockers may mask hypoglycemia. May cause false (+) urine glucose tests or unreliable measurements of 1, 5-AG assay; use alternative methods to monitor glycemic control.
Female genital mycotic infections, nasopharyngitis, UTIs, diarrhea, headache, nausea, vomiting; ketoacidosis, urosepsis, pyelonephritis, acute kidney injury; rare: lactic acidosis.
Generic Drug Availability:
XR tabs 2.5mg/1000mg—60; 5mg/ 500mg, 10mg/500mg—30, 500; 5mg/1000mg—30, 60, 90, 400; 10mg/1000mg—30, 90, 400