Are you also being treated for Type 2 Diabetes? If so, your doctor may have prescribed you a pill that combines two medications. One such commonly prescribed combination is Dapagliflozin and Metformin. You may know it by a brand name like Xigduo XR. Since this is a somewhat special medication, it is very important to be fully informed about it. So, let's talk about everything in a simple and friendly way today.
What really happens with this medicine?
Simply put, the two ingredients in this medicine, Dapagliflozin and Metformin, work together to help control your blood glucose levels. It does this in a few ways. One is by making your kidneys excrete more sugar through your urine. The other is by reducing the amount of sugar your liver makes and by helping your body's cells respond better to insulin.
But this medicine alone is not enough. You can get the best results when you take this medicine along with a proper diet and exercise. It's like a team sport. You, the doctor, this medicine, and your lifestyle have to work together.
Things you need to tell your doctor before starting medication
This is very important. Before you start taking this medicine, you should give your doctor a complete description of your health condition. Especially if you have any of the following conditions, be sure to tell them about it.
| Health condition or habit | Why do you need to tell the doctor ? |
|---|---|
| Kidney or liver disease | This medicine is eliminated from the body through the kidneys, so if there are problems with these organs, the dosage of the medicine may need to be adjusted. |
| Heart disease or low blood pressure | This medicine may lower blood pressure further. |
| If you have pancreatitis | This medicine may increase the risk of the condition recurring. |
| If you drink alcohol frequently | Combining alcohol and Metformin can cause a dangerous condition called lactic acidosis. |
| If you have reduced your food intake due to dehydration or illness/surgery | When the body is dehydrated, the risk of side effects increases. |
| If you have frequent urinary tract infections or yeast infections in the genital area | This medicine increases the risk of developing this infection because it increases the sugar level in the urine. |
| If you have Type 1 Diabetes | This medicine is only recommended for type 2 diabetes. |
| If you are pregnant, trying to get pregnant, or breastfeeding | In these cases, this medicine is not suitable. Therefore, you should talk to your doctor and consider another option. |
| If you have allergies to other medicines, foods, or substances | You may be allergic to something in the medicine. |
How exactly do I use this medicine?
- Drink with a glass of water: It is important to take this medicine at the same time every day, as prescribed by your doctor.
- Swallow the tablet: This is a specially formulated tablet (Extended-Release). This means that the medicine is released into the body gradually. So do not break, crush, or chew the tablet. Swallow it whole.
- Take with food: It is best to take this with a meal to reduce the risk of stomach upset.
- Do not stop: Continue taking the medicine as long as your doctor tells you to. Do not stop taking it arbitrarily.
What if I miss a dose of medicine?
Yes, it can happen. Take the missed dose as soon as you remember. But if it is almost time for your next dose, skip the missed dose and take the next pill at the scheduled time. Never take a double dose.
Other medications that are incompatible with this medicine (Interactions)
It is very important to tell your doctor about all the medications you are taking (including vitamins and traditional medicines), as some medications can interact with this one.
| Don't take medicine with these! | |
|---|---|
| Some types of contrast are given before tests such as X-rays, CT scans, and MRIs. | A medicine called Dofetilide. |
| These may interact - tell your doctor. | |
|
|
This list is not complete, so it's safest to tell your doctor about everything you take.
Special points to be aware of when taking the medicine
- Regular checkups: Your doctor will check you regularly. A blood test called HbA1C is done about once every 2-3 months. It measures how well your blood sugar is being controlled.
- Hypoglycemia: When taking this medicine, especially if you take it with other diabetes medicines such as insulin, your blood sugar levels may drop suddenly. If you experience symptoms such as sweating, trembling, excessive hunger, difficulty concentrating, or fainting, it could be a sign of low blood sugar. Always keep a sugar cube, toffee, or glucose tablet nearby for when this happens.
- High blood sugar and DKA: Sometimes, as with illness, your blood sugar levels can get out of control. If you experience symptoms like excessive thirst, frequent urination, dry mouth, fruity breath odor, stomach pain, and nausea, these could be signs of a dangerous condition called Diabetic Ketoacidosis (DKA) . If this happens, you should seek immediate medical attention.
- Surgery and scans: If you are going to have surgery, an MRI, or a CT scan, tell the medical team in advance that you are taking this medicine. You may need to stop taking the medicine a few days before the procedure .
- The tablet coating: Sometimes the insoluble coating of this medication, the tablet itself, can come out with your stool. This is normal, don't worry about it. The medicine has been absorbed into the body.
- Vitamin B12 and folic acid: Long-term use of metformin can cause low vitamin B12 levels. Talk to your doctor about this and get tested if necessary.
Possible side effects
Like any medicine, this one can have side effects. Some are serious, some are common.
| Symptoms that require you to tell your doctor immediately or go to the ETU | |
|---|---|
| An allergic reaction | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Lactic Acidosis Symptoms | Muscle cramps or pain, stomach pain, difficulty breathing, extreme fatigue. This is a very serious emergency. |
| Symptoms of Diabetic Ketoacidosis (DKA) | Excessive thirst, frequent urination, dry mouth, fruity breath odor, difficulty breathing, stomach ache, nausea/vomiting. |
| Urinary tract infection (UTI) | Urinary tract infection, frequent urination, blood in the urine, back or pelvic pain. |
| Infections in the genital area | Redness, swelling, pain, itching, foul odor, or unusual discharge in or around the genital area. |
| Dehydration | Excessive thirst, dry mouth, fainting, dark urine. |
| It's usually not serious, but if it persists, tell your doctor. | |
| Diarrhea | Nausea/vomiting |
| Headache | Cold-like symptoms (cold) |
If you think you have overdosed, go to your nearest Emergency Department (ETU) immediately. Or call the National Poisons Information Centre at the Colombo National Hospital.
Take-Home Message
- Before starting this medication, tell your doctor about all your medical conditions and all other medications you are taking.
- Swallow the tablet whole with water without breaking, crushing, or chewing.
- Be aware of the symptoms of hypoglycemia and DKA, which can occur when blood sugar levels are too high. It is important to know what to do in such cases.
- Avoid drinking alcohol. Tell your doctors that you are taking this medicine before having surgery or a scan.
- If you experience any serious side effects or are in any doubt, consult your doctor immediately or go to an Emergency Department (ETU).
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