Dapagliflozin/metformin

Green-G

Brand Name(s):Xigduo

Indication:Diabetes Mellitus Type 2 in adults 18 years and older as an adjunct to diet and exercise to improve glycaemic control

Rationale:

Considered:Jan-14

Review Date:Feb-24

Comments:
Non-Formulary
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Drug Safety Update
SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
Feb 2019
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NICE NG28 Update Type 2 diabetes in adults: management
May 2017
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Drug Safety Update
Risk of diabetic ketoacidosis
April 2016
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NICE guidelines (NG28)
Diabetes in adults:management
Document available at:https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-1837338615493
Dec 2015
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NICE guidelines [NG18]
Diabetes (type 1 and type 2) in children and young people: diagnosis and management
Full document available at:http://www.nice.org.uk/guidance/ng18
Aug 2015
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Drug Safety Update
MHRA advises clinicians to test for raised ketones in patients on SGLT2 inhibitors.
Full guidance available at:https://www.gov.uk/drug-safety-update/sglt2-inhibitors-canagliflozin-dapagliflozin-empagliflozin-risk-of-diabetic-ketoacidosis
June 2015

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Guidance taken from:Doncaster & Bassetlaw Medicines Formulary

Dapagliflozin in a dual therapy regimen in combination with metformin is recommended for the treatment of type 2 diabetes, only if glycaemic control is inadequate, and the patient has a significant risk of hypoglycaemia or if a sulfonylurea is contra-indicated or not tolerated (NICE Guidance TA288).
Dapagliflozin in combination with insulin (alone or with other antidiabetic drugs) is an option for the treatment of type 2 diabetes (NICE Guidance TA288).
Dapagliflozin should be avoided if eGFR is less than 60ml/minute/1.73m2, and therefore may be unsuitable for some diabetic patients.
Oct 2013
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NICE TA 288
http://www.nice.org.uk/nicemedia/live/14193/64270/64270.pdf
Issued: June 2013