Dr. Ahmed Here are a few scenarios where patients may ask you: Can I take Xigduo at night?
Patient 1: I am a night shifter!
I am a patient with diabetes type 2. My doctor recently prescribed me Xigduo XR 5/1000 mg. I have been asked to take it in the morning after breakfast.
My question is: Can I take Xigduo at night?
The reason why I am asking is that I am a night shifter. I work all night and go to sleep in the morning. My breakfast is like my dinner and I eat my first meal in the evenings.
I have read that Xigduo XR can make you pee since it works on your kidneys blocking sugars coming back from your urine to your blood. That would ruin my sleep if I take it before I go to sleep.
Discussion:
Xigduo XR is a combination pill of Dapagliflozin and metformin. Dapagliflozin is an SGLT2 inhibitor that works by inhibiting glucose reabsorption from the renal tubules into the plasma.
This results in pouring out glucose and water into the urine. Thus people taking dapagliflozin or Farxiga as monotherapy or in combination with metformin as Xigduo or Xigduo XR are likely to pee more than usual.
It is best to take Xigduo XR in the morning times as taking it at night may wake a person from sleep. Polyuria or excessive urination is especially a problem with Xigduo or any other SGLT2 inhibitors in the following situations:
The person has high blood glucose:
The higher the plasma glucose, the more glucose will be excreted in the urine. Thus, more chances of going to the washroom to pass urine.
The person has a UTI:
A UTI (urinary tract infection) is associated with frequent urination. One of the side effects of Xigduo is frequent urination and urinary tract infection.
People, especially women, with preexisting UTIs may develop more serious infections with Xigduo or dapagliflozin.
Prostatic problems in men:
Prostate enlargement results in frequent urination, urinary urgency, urinary hesitance, and increased chances of UTIs. Men with BPH may notice a worsening of their symptoms after starting Xigduo or dapagliflozin.
Xigduo XR can be prescribed at night if a person is a night shifter and has a reversed sleeping pattern.
Patient 2: Taking Xigduo and Amaryl may increase the chances of hypoglycemia:
I am a type 2 diabetic patient. I take Amaryl and metformin tablets (Glimepiride + metformin) in the morning. My doctor prescribed my Xigduo XR 5/1000 mg after my recent A1C was high (8.5%).
I have been asked to take Xigduo XR after breakfast. However, I am worried since my breakfast is light and I take Amaryl MSR just before breakfast.
Taking Xigduo after breakfast can upset my stomach. Secondly, I am also worried about low sugars in the daytime.
Can I take Xigduo at night?
Discussion:
One great suggestion, in this case, would be to take Amaryl MSR before breakfast and take Xigduo XR after lunch.
However, taking Xigduo after breakfast is not going to cause hypoglycemia if the baseline blood sugars are high or uncontrolled. This is because Xigduo XR is not a rapid or short-acting medicine that works instantly.
It has a longer half-life of about 12 hours and is effective for 24 hours or more.
Xigduo XR may be taken at night as well but it may cause nighttime urination, especially during the first week of treatment initiation when the blood glucose is high.
Once the blood glucose is under control, it is not significantly associated with polyuria.
Suggestion:
It is best to take Xigduo at lunch in this scenario.
Take Xigduo XR at night to reduce insulin resistance!
Some people also believe taking metformin at night is best to avoid GI upsets and to simultaneously reduce insulin resistance.
It is logical as in waking hours, people walk and burn calories, reducing insulin resistance. At night, when the metabolic rate is the slowest, insulin resistance is at the peak and metformin may help cover the fasting blood glucose.
Taking Xigduo XR at night increases the risks of UTIs!
This is another area of concern. One of the most frequent side effects of SGLT2 inhibitors is UTI. UTI is more common with Xigduo XR in women, people with uncontrolled diabetes, immunocompromised patients, and people with BPH or urethral strictures.
However, when Xigduo is taken at night, the risk of UTIs may increase. This is believed to be caused by holding urine in the bladder for a long time.
The more urine stays in the bladder, the greater the chances of infection. This is one reason why Xigduo should not be taken at night.
- Question of
Does Xigduo make you pee more?
- Question of
Do you think Xigduo should only be taken in the morning?
- Question of
Does taking Xigduo at night increases the risk of hypoglycemia?
- Question of
Does taking Xigduo at night increases the risk of UTI?
- Question of
Is Xigduo more effective at night?
