Can you take Farxiga and metformin together?

In this article:

• Can you take Farxiga and metformin together?
• Why are they prescribed together?
• Potential risks
• Usage instructions
• How to save
• The bottom line

In this article

• Can you take Farxiga and metformin together?
• Why are they prescribed together?
• Potential risks
• Usage instructions
• How to save
• The bottom line

Farxiga (dapagliflozin) is a prescription medication FDA-approved to treat high blood sugar (hyperglycemia) in people with Type 2 diabetes mellitus, chronic kidney disease (CKD), and heart failure. The sodium-glucose cotransporter 2 (SGLT2) inhibitor works by blocking the reabsorption of glucose (blood sugar) from the kidneys into the bloodstream, thus helping lower blood sugar levels and reducing the risk of kidney damage. Metformin (brand name Glucophage) is a prescription drug that is often combined with diet and exercise to improve blood sugar levels in adults with Type 2 diabetes. It falls under the class of drugs called biguanides, which reduce the amount of blood sugar that gets absorbed into the liver. According to research and medical experts, it’s safe to take Farxiga and metformin (sometimes prescribed at Xigduo) together for glycemic control. 

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Can you take Farxiga and metformin together?

Jennifer Brown, MD, ABOM, ABFM, a board-certified physician in obesity medicine and family medicine, and obesity expert for My Obesity Team of Lewisburg, West Virginia, says it’s safe and very common for Farxiga and metformin to be taken together. “The two medications work by different mechanisms to lower blood glucose levels,” she explains. “In addition, many patients who have diabetes are at risk for heart disease and chronic kidney disease, so it makes sense to use Farixga with metformin in diabetic patients. I routinely prescribe the two medications together, especially for patients who already have heart disease or chronic kidney disease.”

A randomized, placebo-controlled clinical trial found that twice-daily dapagliflozin co-administered with metformin was more effective in reducing blood sugar levels in patients with Type 2 diabetes than just metformin treatment alone. 

When it comes to specific dosages, Dr. Brown prescribes both Farxiga and metformin at the lowest possible dosages, then increases them as needed to control blood sugar levels. “The maximum doses I prescribe for patients are Farxiga 10 mg daily and metformin 2,000 mg daily,” she says.

Akhil Shenoy, MD, a board-certified physician in internal medicine and endocrinology at Wellspire Medical in Houston, Texas, and Medical Advisor at Aeroflow Diabetes, dosage may be adjusted based on tolerance of side effects, presence of contraindications, and clinical need.

If your healthcare provider prescribes the two anti-diabetic medications concurrently, they’ll provide guidance on the best dosages to keep your glucose levels under control.

Why are Farxiga and metformin sometimes prescribed together?

According to Dr. Shenoy, diabetes medications such as Farxiga and metformin are often added to a patient’s treatment plan for better blood sugar control. “For example, if sugars are still high with one drug, then another is added,” he explains. “Both medications benefit the heart. Dapagliflozin has an additional benefit for the kidneys and high blood pressure.”

Additional benefits of taking Farxiga and metformin together include:

• Weight management: Research suggests that combining two anti-diabetic medications can lead to greater weight loss (up to 2%) than one alone. 
• Lower risk of hypoglycemia: The same research study also revealed that a combination of the two prescription drugs could lower the risk of hypoglycemia or dangerously low blood sugar because of the once-daily dosing.
• Better medication adherence: Researchers also found that a fixed-dose combination of Farxiga and metformin helped patients stick to their regimen (correct, dose, timing, frequency, and duration) while managing their Type 2 diabetes. 
• Cardiorenal protection: Farxiga reduces the risk of cardiovascular disease and kidney failure in people with Type 2 diabetes, and slows the progression of CKD and end-stage kidney disease (ESKD) in people with and without diabetes.

Are there any risks associated with taking Farxiga and metformin together?

“There are no specific risks associated with combining these two medications, except for the potential for low blood sugar,” Dr. Brown says. “As with any diabetic medication, it’s essential to monitor A1C, as well as liver and kidney function blood tests.”

While there’s no drug interaction, it’s essential to be aware of the potential side effects that each medication may cause.

Common side effects of Farxiga include:

• Urinary tract infection (UTI)
• Genital mycotic infections, such as vaginal yeast infections
• Urinary frequency or discomfort
• Nausea
• Back pain
• Constipation
• Extremity pain
• Elevated creatinine levels

Taking metformin may lead to an increased risk of the following side effects:

• Nausea or vomiting
• Diarrhea
• Upset stomach
• Low energy
• Gas
• Headache
• Low vitamin B12 levels

More serious side effects of both Farxiga and metformin include:

• Hypersensitivity or anaphylaxis (severe, life-threatening allergic reactions)
• Acute kidney injury or renal impairment (reduced kidney function)
• Diabetic ketoacidosis (DKA) 
• Orthostatic hypotension (severe drop in blood pressure upon sitting or standing up)
• Fournier gangrene
• Serious UTI
• Lactic acidosis

In addition to side effects, it’s important to be aware of potential drug interactions or contraindications that could occur while taking Farxiga and metformin together. 

Please seek immediate medical attention if you experience any serious side effects while taking these anti-diabetic drugs.

If you believe you’ll benefit from a combined treatment of Farxiga and metformin, please speak with your healthcare provider before mixing medications. 

How to take Farxiga and metformin together

While it’s safe to take Farxiga and metformin together, you can lower your risks of side effects by following your healthcare provider’s instructions. “I recommend that my patients take metformin with food to help manage potential GI side effects, like nausea or diarrhea,” Dr. Brown says. “I also encourage them to check their blood glucose levels more frequently when starting a new diabetic medication or when the dose of an existing diabetic medication is increased.”

Below are other tips to consider while taking these two drugs together:

• Avoid crushing, breaking, or chewing the oral tablets.
• If you are taking extended-release metformin (Metformin XR), a portion of the medication may pass into your stools, which is completely normal.
• Regularly test for sugar in your blood or urine as directed by your healthcare provider.
• If you miss a dose, take it as soon as possible; however, if it’s almost time for your next dose, skip the missed dose and return to your regular dosing schedule. Avoid double-dosing.
• Store medications in a closed container at room temperature, away from heat, moisture, and direct sunlight.
• Avoid drinking alcohol, as it can cause severe low blood sugar and increase the risk of lactic acidosis.

If you have any questions or concerns about your treatment, please contact your healthcare provider or refer to the Medication Guide that comes with your medications for professional medical advice. 

How to save on Farxiga and metformin

Prescription medications like Farxiga and metformin can get pricey if you’re uninsured or underinsured. If you find your out-of-pocket costs are a bit too high for one or both anti-diabetic medicines, here are some ways you can save money:

• Manufacturer savings card: AstraZeneca, the manufacturer of Farxiga, offers a savings card that may make it possible to pay as little as $0 per month. You must be 18 years old, have commercial insurance, and be a United States or Puerto Rico resident to be eligible for this savings card. 
• Patient assistance programs: The AZ&Me Prescription Savings Program helps patients with Medicare or those who are uninsured access AstraZeneca medications, such as Farxiga, at no cost. You must be 18 years old, receive treatment from a U.S. healthcare provider, not have commercial insurance, and not be receiving any other medication payment assistance. If eligible, you’ll be enrolled in the program for a year and have the ability to reapply. 
• SingleCare savings card: This free discount card can help you locate Farxiga and metformin at a lower cost. With this coupon, you can pay as low as $360.90 for 30, 10 mg tablets of Farxiga and $9 for 60, 500 mg tablets of Metformin. To get your savings, simply click “Get free coupon” on your preferred pharmacy, print out or download the coupon to your mobile device, and show it to your pharmacist.

The bottom line

It’s safe to take both Farxiga and metformin together to manage blood sugar levels in people with Type 2 diabetes mellitus. If you think you could benefit from this drug combination, please consult your healthcare provider for medical guidance.