Farxiga Vs. Metformin: Drug Comparison

Farxiga^® (dapagliflozin) is an oral sodium-glucose cotransporter 2 (SGLT2) inhibitor used to treat type 2 diabetes, heart failure, and chronic kidney disease. It lowers blood sugar by promoting glucose excretion through the urine. Farxiga is indicated for reducing the risk of estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, cardiovascular death, and heart failure hospitalization in adults with chronic kidney disease. Additionally, it reduces the risk of cardiovascular death, heart failure hospitalization, and urgent heart failure visits in adults with heart failure. It decreases heart failure hospitalization risk in adults with type 2 diabetes and cardiovascular disease or risk factors. Farxiga also aids in improving glycemic control alongside diet and exercise in adults and children aged 10 and older with type 2 diabetes. Common side effects include urinary and genital infections, and it may cause rare but serious conditions like ketoacidosis and dehydration.

Metformin is an oral medication commonly prescribed to manage blood sugar levels in individuals with type 2 diabetes. It works by decreasing glucose production in the liver, improving the body's sensitivity to insulin, and reducing the amount of sugar absorbed by the intestines. Metformin is often used as a first-line treatment due to its efficacy, safety profile, and additional benefits, such as weight stabilization and low risk of low blood sugar. Common side effects include gastrointestinal issues like nausea, diarrhea, and abdominal discomfort.

Sodium-glucose cotransporter 2 (SGLT2) inhibitor

Biguinide

Farxiga (dapagliflozin) is indicated:

• To reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression

• To reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure

• To reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus

Metformin hydrochloride tablets are indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus

• Typically taken orally once daily

• Comes in 5 mg and 10 mg tablets

• Typically taken orally once, twice, or three times daily

• Comes in 500 mg, 850 mg, and 1,000 mg tablets

Most common adverse reactions (5% or greater incidence) were:

• Female genital fungal infections

• Inflammation of the nasal cavities and back of the throat

• Urinary tract infections

For metformin hydrochloride, the most common adverse reactions (>5%) are:

• Diarrhea

• Nausea/vomiting

• Flatulence

• Weakness

• Indigestion

• Abdominal discomfort

• Headache

• History of serious hypersensitivity reaction to dapagliflozin or any of the excipients in Farxiga

• See the Full Prescribing Information for information on drug interactions and interference of Farxiga with laboratory tests

• Severe renal impairment (eGFR below 30 mL/min/1.73 m²)

• Hypersensitivity to metformin

• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma

• Drug interactions: Carbonic anhydrase inhibitors, drugs that reduce metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine), alcohol

• Diabetic ketoacidosis in patients with type 1 diabetes mellitus and other ketoacidosis

• Volume depletion

• Urosepsis and pyelonephritis

• Low blood sugar

• Necrotizing fasciitis of the perineum (Fournier’s gangrene)

• Genital fungal infections

• Pregnancy: Potential risk to a fetus especially during the second and third trimesters

• Lactation: Not recommended when breastfeeding

• Lactic acidosis: See Boxed Warning

• Vitamin B12 deficiency: Metformin may lower vitamin B12 levels

• Low blood sugar with concomitant use with insulin and insulin secretagogues

• Females and males of reproductive potential: Potential for an unintended pregnancy

WARNING: LACTIC ACIDOSIS

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information.

If lactic acidosis is suspected, discontinue metformin hydrochloride tablets and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.

*This information is from the label for brand name Farxiga^®. See the Full Prescribing Information for more complete information.

*This information is from the metformin hydrochloride label used by Epic Pharma, LLC. See the Full Prescribing Information for more complete information. Metformin may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient metformin.