Dr. Ahmed
Farxiga and Ozempic together are some of the best diabetes combination medicines.
The recent ADA 2023 guidelines recommend using a potent SGLT-2 inhibitor or a GLP-1 analog with established cardiovascular benefits as the first line of treatment for lowering the risks of ASCVD (atherosclerotic cardiovascular disease).
In addition, for diabetic patients with heart failure, the first-line treatment recommended by the ADA is the addition of an SGLT2 inhibitor or a GLP-1 analog.
Among the potent SGLT2 inhibitors that reduce the risk of ASCVD and heart failure include:
- Empagliflozin (Jardiance)
- Dapagliflozin (Farxiga)
- Canagliflozin (Invokana), and
- Ertugliflozin (Steglatro)
Among the GLP-1 analog, the recommended ones for heart failure and for reducing the risk of ASCVD are:
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What are the benefits of taking Farxiga and Ozempic together?
Better Glucose Control:
If your blood glucose was not controlled with Ozempic and metformin alone, adding Farxiga is one of the best choices.
The maximum A1C lowering effect of Ozempic is 1.8%. If you add Farxiga, you may achieve a maximum A1C lowering effect of up to 2.3%.
Greater weight loss:
In addition, Ozempic and Farxiga together can help you lose weight faster than with Ozempic alone. Although both Farxiga and Ozempic are not weight loss drugs, they are used off-label for weight loss.
The expected weight loss with higher doses of Ozempic is about 15% of your body. When Farxiga and Ozempic are used together, you may lose weight faster and more than if you are using Ozempic alone.
Greater cardiovascular and Renal benefits:
Both Farxiga and Ozempic reduce the risks of atherosclerotic cardiovascular diseases. In addition, SGLT2 inhibitors are used to treat patients with heart failure.
The combination of Ozempic and Farxiga may reduce the risks of renal and cardiovascular diseases better than with each drug used alone.
In addition, to improvement in the symptoms of heart failure, your blood pressure readings may improve as well.
Low risks of UTI:
When the blood glucose is elevated, urinary glucose will be high too. This is more if you are taking Farxiga.
The combination of Farxiga and Ozempic together will lower the blood glucose and hence the urinary glucose will reduce resulting in a reduction in the risks of UTIs.
Pros of Combining Farxiga and Ozempic together: |
| Better glucose control |
| Greater weight loss |
| Rapid weight loss |
| Greater cardiovascular benefits |
| Greater Renal benefits |
| Reduce the risk of UTI |
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What are the CONS of taking Farxiga and Ozempic together?
If you are on Ozmepic and Farxiga, your cost of treatment will increase by about 30 to 50%. In addition, you will have to take one pill extra per day which may be a problem in old age as people forget their doses.
More side effects:
More medicines mean more side effects too. Adding Farxiga to Ozempic may increase the risks of drug-related side effects including urinary and genital infections, dehydration, hypotension, and renal failure.
Ozempic use is associated with nausea and vomiting which may cause dehydration and renal failure.
Similarly, Farxiga causes osmotic diuresis which may also lead to dehydration and increase the risks of acute renal failure.
The risks of hypoglycemia are also markedly increased especially in patients with normal glucose control at the baseline.
Patients may report dizziness, sweating, and palpitations, and may become drowsy if the blood glucose falls dangerously low.
Increased risk of Ketoacidosis:
Farxiga is associated with an increased risk of ketoacidosis (euglycemic ketoacidosis).
If your doctor switches you to Ozempic and Farxiga from a combination of insulin and metformin, the risks of euglycemic ketoacidosis may be high, especially during the first few weeks of switching to the new regimen.
Monitor your blood glucose and ketones if you develop abdominal pain, vomiting, and nausea. You should visit the ER urgently as you may need IV fluids and IV insulin infusion.
Cons of Farxiga and Ozempic together: |
| Pill burden and increased cost |
| Increased risk of acute renal failure |
| Increased risk of hypoglycemia |
| Increased risk of ketoacidosis |
| Increased risk of hypotension |
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In summary:
Ozmepic and Farxiga when used together by diabetics may help them better control their blood glucose, reduce weight faster, and reduce the risks of cardiovascular diseases.
However, at the same time, the risks of hypoglycemia, ketoacidosis, and hypotension will increase.
In addition, Farxiga and Ozempic can also be used with metformin. The triple combination is more commonly used.
Because metformin is considered the first-line medicine, AstraZeneca has launched Xigduo, a combination of Farxiga and metformin combo in a single tablet.
Xigduo with Ozempic is a more preferred combination than Farxiga and Ozempic. However, for patients who are intolerant to metformin, Farxiga + Ozempic is a good choice too.
