Mounjaro And Farxiga Or Jardiance Together: Pros And Cons

Mounjaro and Farxiga or Jardiance are two different classes of medications approved for treating individuals with diabetes mellitus type 2. These drugs have different mechanisms of action and work totally in different ways.

Mounjaro is the brand name of Tirzepatide. It is a twincretin that acts by enhancing the effects of the two incretins (hence the name Twincretin), GLP-1 and GIP.

By activating these incretins, Mounjaro lowers blood glucose without causing hypoglycemia and suppresses appetite via different mechanisms, but delaying stomach emptying is the primary one.

Farxiga and Jardiance are two drugs from the class SGLT2 inhibitors. These drugs lower blood glucose by inhibiting the filtered glucose in the renal tubules from re-entering the blood.

Thus, Jardiance and Farxiga cause the filtered glucose to get excreted via the kidneys. These drugs do not affect insulin production or insulin resistance.

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How are Mounjaro and Farxiga/ Jardiance similar?

Mounjaro and Farxiga or Jardiance are considered the blockbuster medications that have changed the whole diabetes guidelines.

These medicines not only help in lowering blood glucose but they are also best for people with cardiac or renal dysfunction.

Here is a table summarizing the similarities between Mounjaro and Farxiga/ Jardiance.

How are Mounjaro and Farxiga/ Jardiance Similar?
Primary Indications	Both drugs are FDA-approved primarily for the treatment of Diabetes Type 2. Tirzepatide has been recently approved by the FDA for treating Obesity.
Efficacy	Both drugs are very effective in lowering plasma glucose and A1C
No hypoglycemia	There is no or very little risk of hypoglycemia with both these medications
Safety	Both drugs are generally very well tolerated and very safe
Safety in ASCVD	Both drugs are safe and have a beneficial role in ASCVD patients.

Jardiance and Farxiga are both covered by most insurance plans but Mounjaro’s insurance cover is limited.

How are Mounjaro and Farxiga/ Jardiance different?

Although both Mounjaro and Farxiga or Jardiance are FDA-approved diabetes medications, these drugs are different in certain ways.

One important clinical difference is that Mounjaro is considered the most potent diabetes medicine and lowers the A1C by up to 2.4% which is even greater than Ozempic and Insulin.

Farxiga and Jardiance are less potent than most diabetes medications including metformin.

Among the SGLT2 inhibitors, Jardiance is more effective than Farxiga. Jardiance lowers the A1C by 0.9% while Farxiga lowers the A1C by 0.6 to 0.8%.

Here is a table summarizing the differences between Mounjaro and Farxiga/ Jardiance:

	Mounjaro	Farxiga/ Jardiance
Drug Names	Tirzepatide	Dapagliflozin/ Empagliflozin
Class	Dual GLP-1 and GIP analog	SGLT2 inhibitors
Mechanism of action	Glucose-dependent insulin production and suppresses appetite	Causes glucose excretion via the kidneys
FDA-approved indications	Type 2 diabetes Obesity	Type 2 diabetes Heart failure (both HFrEF and HFpEF)
Administration	Subcutaneous injection	Orally
Frequency of dosing	Once a week	Once daily
Efficacy	Highly effective in lowering A1C (the most effective)	Effective
Common side effects	GI side effects such as nausea, bloating, constipation/ diarrhea	Genital yeast infection and urinary tract infections
Serious Side effects	Pancreatitis Thyroid cancer Kidney injury	Fournier’s gangrene Kidney injury Euglycemic ketoacidosis

Can you use Mounjaro and Farxiga/ Jardiance together?

Mounjaro can be safely used with Jardiance or Farxiga. In fact, combining these two classes of medicines may exert additional benefits which are listed in the table below:

Pros of using Mounjaro and Farxiga/ Jardiance together
Better glucose control	Mounjaro lowers the A1C by 2.4% and is the most potent diabetes medicine. Adding Jardiance or Farxiga can further lower the A1C, especially in patients who have not achieved their glucose and A1C targets.
Greater weight loss effects	Tirzepatide got FDA approval for weight loss under the brand name Zepbound. In clinical trials, its use was associated with greater weight loss than Ozempic and Wegovy (Wegovy is an FDA-approved weight loss drug). Mounjaro, in clinical trials, results in a weight loss of more than 20%. Jardiance and Farxiga are not weight loss drugs, however, because of their glucosuric effects, they have been seen to cause a weight loss of about 2 to 5%. Combining these drugs can result in more weight loss than either drug alone.
Best for cardiac patients	Farxiga and Jardiance have been approved for the treatment of heart failure in patients with a reduced ejection fraction as well as a preserved ejection fraction (HFrEF and HFpEF). Mounjaro, like Ozempic, is one of the first lines of medicine for the treatment of patients with ASCVD (atherosclerotic cardiovascular disease) according to the ADA 2023 guidelines. The combined use of Mounjaro with Farxiga or Jardiance can result in more cardiovascular benefits.
No added GI side effects	The most common side effects of Mounjaro are related to the GI tract. In fact, nausea, bloating, constipation, or diarrhea are a few symptoms that are the reasons that the patient has to discontinue Mounjaro. Unlike metformin, adding Jardiance or Farxiga does not result in more GI side effects and hence these drugs are better tolerated by patients compared to the combined use of Mounjar and Metformin.
Minimal risk of hypoglycemia	Mounjaro and Farxiga or Jardiance are both considered euglycemic drugs. This means that both these drugs lower blood glucose only when their levels are high. Adding Farxiga or Jardiance to Mounjaro does not increase the incidence of hypoglycemia.

It is evident from the table above, that these two classes of medicines can be used together and may have more advantages than using either drug alone.

However, both Mounjaro and Farxiga or Jardiance are costly and can not be afforded by everyone unless covered by insurance.

In addition, Mounjaro causes GI side effects like nausea, bloating, and diarrhea which may increase the incidence of renal failure while Farxiga and Jardiance cause water loss (osmotic diuresis) as a result of their glucosuric effects.

Dehydration is a side effect of all SGLT2 inhibitors including Jardiance and Farxiga which may increase the incidence of renal failure.

Here is a table summarizing the Cons of combining Mounjaro with Farxiga or Jardiance.

Cons of using Mounjaro and Farxiga/ Jardiance together
Costly	The cost of Mounjaro is about $950 USD per month. The monthly cost of Farxiga is about $600 USD and that of Jardiance is about $700 USD. These are costly medications and adding them will add to the cost.
Increased risk of retinopathy	All drugs that act on the GLP-1 and those that lower the A1C rapidly can worsen preexisting diabetic retinopathy. Jardiance and Farxiga have also been observed to cause blurring and eye-related side effects primarily via volume contraction. Combining these drugs may increase the eye-related side effects including an increased risk of diabetic retinopathy.
Increased risk of renal failure	Jardiance or Farxiga reduces the progression of patients with diabetic nephropathy to end-stage renal failure. They are commonly used for the treatment of patients with diabetic nephropathy. However, because these drugs can cause dehydration, they may increase the risk of acute renal failure. The risk is highest when it is given with diuretics or in patients with a rising creatinine and acute settings. Similar to Jardiance and Farxiga, Mounjaro may also cause renal failure in acute settings in patients who are volume-depleted.

In conclusion:

Combining Mounjaro and Farxiga or Jardiance may result in better glucose control, and more weight loss, and exert beneficial effects in patients with heart failure and stable kidney disease without added GI side effects.

However, they may increase the cost and may result in acute renal failure if given in acute settings.