Combination Therapies

What are combination therapies

Combination therapies for type 2 diabetes combine two medications in a single tablet to make it more convenient for people with type 2 diabetes. There are several different combination therapies available. People with type 2 diabetes may have to try different medications to find the right treatment that work best for their bodies. Always check with your healthcare provider about the best way to take any medication and about any potential drugs interactions before starting new medications. Also, report any side effects that you may experience to your healthcare provider.

Combination therapies are sold under some of the following brand names:

What are ActoPlus Met (pioglitazone HCl and metformin HCl) and ActoPlus Met XR (pioglitazone HCl and metformin HCl extended-release)?

ActoPlus Met combines the medicine in Actos® (pioglitazone HCl) and metformin in a single tablet. ActoPlus Met XR is an extended-release formulation of pioglitazone HCl and metformin, which may be prescribed if someone is having fluctuations in their blood sugar control between doses of their medication. While pioglitazone (a thiazolidinedione) works by increasing the body’s sensitivity to insulin, metformin (a biguanide) reduces the amount of glucose produced by the liver. ActoPlus Met is prescribed for people with type 2 diabetes who have previously tried treatment with metformin or a thiazolidinedione alone and who still have problems with glycemic control. ActoPlus Met comes in a tablet that is taken by mouth either once or twice daily, and ActoPlus Met XR comes in a tablet that is taken once daily. Some common side effects experienced by patients taking ActoPlus Met or ActoPlus Met XR include upper respiratory tract infection, weight gain, diarrhea, fluid retention causing swelling in the legs (edema), and headache. Rarely, serious side effects may occur with ActoPlus Met and ActoPlus Met XR, including developing congestive heart failure and lactic acidosis (a build up of lactate in the body), which may lead to death. People with kidney disease, acute or chronic metabolic acidosis (including diabetic ketoacidosis), symptoms of heart failure, severe kidney disease, or an allergy to any of the ingredients in ActoPlus Met or ActoPlus Met XR should not take ActoPlus Met or ActoPlus Met XR. Patients taking ActoPlus Met or ActoPlus Met XR should check with their physician about stopping their medication if they are getting radiologic testing involving iodinated contrast materials, due to an increased risk of kidney damage. Patients should have kidney function checked prior to starting these drugs.

What is Avandaryl (rosiglitazone/glimepiride)?

Avandaryl is a combination of rosiglitazone and glimepiride and is used in addition to diet and exercise for the control of blood sugar in adults with type 2 diabetes. Rosiglitazone is a thiazolidinedione and works by increasing the body’s sensitivity to insulin. Glimepiride is a sulfonylurea and stimulates the pancreas to produce more insulin. Avandaryl comes as a tablet to be taken by mouth. Avandaryl should not be taken by people with heart failure or those who are allergic to sulfonamide derivatives or any of the ingredients in Avandaryl. The most common side effects experienced by patients taking Avandaryl are headache, low blood sugar, and upper respiratory infections. Some people may experience serious side effects with Avandaryl, such as heart failure. Patients should obtain liver function tests prior to starting this medication.

What is Avandamet (rosiglitazone maleate and metformin HCl)?

Avandamet combines two medications to treat type 2 diabetes, rosiglitazone and metformin. Rosiglitazone is a thiazolidinedione and helps increase the body’s sensitivity to insulin. Metformin decreases the amount of glucose produced by the liver. Avandamet is used in conjunction with diet and exercise to help people with type 2 diabetes control their blood sugar. It comes as a tablet to be taken with meals. Some of the most common side effects experienced by patients taking Avandamet are low blood sugar, nausea, vomiting, diarrhea, headache, and indigestion. Avandamet may cause serious side effects, including congestive heart failure, myocardial ischemia (in which blood flow to the heart is blocked), or lactic acidosis. Some people should not take Avandamet, such as those with heart failure, kidney disease or dysfunction, acute or chronic metabolic acidosis, those who are allergic to any ingredients in Avandamet, or patients who are undergoing radiologic testing involving iodinated contrast materials. Patients should have their kidney function checked prior to stating this medication.

What is Duetact (pioglitazone HCl and glimepiride)?

Duetact contains two medications that lower the amount of glucose in the blood: Actos (pioglitazone) and Amaryl (glimepiride). Actos decreases insulin resistance, and Amaryl is a sulfonylurea drug that works by stimulating the release of insulin from the pancreas. Duetact is prescribed as an addition to diet and exercise to improve blood glucose control in people with type 2 diabetes who have previously tried treatment thiazolidinedione or a sulfonylurea alone and who still have problems controlling their blood sugar. Duetact comes in a tablet to be taken by mouth once daily. Some of the most common side effects experienced by patients taking Duetact include upper respiratory tract infection, diarrhea, low blood sugar, weight gain, headache and fluid retention causing swelling in the legs (edema). Rarely, people taking Duetact experience congestive heart failure. People who have diabetic ketoacidosis or who have a known allergy to any of the ingredients in Deutact should not take Duetact. Patients should obtain liver function tests prior to starting this medication.

What is Glucovance (glyburide/metformin HCl)?

Glucovance is used in conjunction with diet and exercise to help people with type 2 diabetes control their blood sugar. Glucovance combines glyburide, a sulfonylurea, and metformin. Glyburide stimulates the pancreas to release more insulin, and metformin reduces the amount of glucose that is produced by the liver. Glucovance may be prescribed if a person’s blood sugar is not controlled with treatment using a sulfonylurea or metformin alone. Glucovance comes in a tablet that is taken twice daily with morning and evening meals. Some of the most common side effects experienced by patients taking Glucovance are upper respiratory infections, diarrhea, headache, nausea, vomiting, abdominal pain, and dizziness. Some people should not take Glucovance, including those with kidney disease or dysfunction, acute or chronic metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Glucovance. Glucovance should be temporarily discontinued in people who are undergoing radiologic testing involving iodinated contrast materials, check with your prescriber. Patients should have kidney function checked prior to starting this medication.

What is Glyxambi (empagliflozin/linagliptin)?

Glyxambi is a prescription medication used in combination with diet and exercise to improve blood sugar control in people with type 2 diabetes. Glyxambi contains two medications: empagliflozin and linagliptin. Empagliflozin is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor and works by stopping the reabsorption of glucose from the kidneys so that more of the glucose in the body is excreted in the urine. Linagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that works by increasing levels of incretin hormone, thus increasing the amount of insulin produced by the body after meals when blood sugar is high and decreasing the amount of glucagon (a hormone that raises blood sugar) that is produced by the body. Glyxambi is a tablet that is taken once daily in the morning, with or without food. The most common side effects experienced by people taking Glyxambi are urinary tract infection, upper respiratory infection, and nasopharyngitis. Glyxambi may increase the risk of developing pancreatitis (inflammation of the pancreas) and may cause some people to experience dehydration or ketoacidosis. People with severe kidney impairment, end-stage renal disease, or who are on dialysis should not take Glyxambi. People with an allergy or hypersensitivity reaction to linagliptin, empagliflozin, or any of the ingredients in Glyxambi should not take Glyxambi. Patients should have kidney function tested before starting treatment with Glyxambi.

What is Kazano (alogliptin/metformin HCl)?

Kazano is a combination of alogliptin and metformin used along with diet and exercise to improve blood sugar control in people with type 2 diabetes. Alogliptin is a DPP-4 inhibitor that increases incretin hormones to increase the amount of insulin produced by the pancreas, while metformin works to manage blood sugar by reducing the amount of glucose produced by the liver. Kazano comes as a tablet that is usually taken twice daily with food. Before starting treatment with Kazano, people should have a test to check their kidney function. Some of the most common side effects experienced by people taking Kazano include upper respiratory tract infections, colds, diarrhea, hypertension, headache, back pain, and urinary tract infections. Kazano should not be used by people with severe kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Kazano.

What is Kombiglyze XR (saxagliptin/ metformin HCl extended-release)?

Kombiglyze XR is used in combination with diet and exercise to treat people with type 2 diabetes. Kombiglyze XR blends saxagliptin and an extended-release formulation of metformin. Saxagliptin is a dipeptidyl-peptidase-4 (DPP4) inhibitor, which works on incretin hormones to increase the amount of insulin produced by the pancreas. Metformin reduces the amount of glucose produced by the liver. Kombiglyze XR comes as a tablet that is taken once daily, usually with the evening meal. Some of the most common side effects experienced by people taking Kombiglyze XR are diarrhea, nausea, vomiting, upper respiratory tract infections, urinary tract infections, and headache. Rarely, Kombiglyze XR may cause serious side effects, such as lactic acidosis. Some people should not take Kombiglyze XR, including those with kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Kombiglyze XR. Patients should have kidney function checked prior to starting treatment with Kombiglyze XR.

What are Invokamet (canagliflozin/metformin HCl) & Invokamet XR (canagliflozin/metformin HCl extended-release)?

Invokamet contains an SGLT2 inhibitor, canagliflozin, and metformin. Invokamet XR combines canagliflozin with an extended-release formulation of metformin. Both Invokamet and Invokamet XR are used with diet and exercise to improve blood sugar control in adults with type 2 diabetes. Canagliflozin stops the reabsorption of glucose from the kidneys so that more of the glucose in the body is excreted in the urine, while metformin reduces the amount of glucose produced by the liver. Invokamet comes as a tablet that is usually taken twice daily with meals. Invokamet XR is usually taken once daily with the morning meal. Some of the most common side effects experienced by people taking Invokamet and Invokamet XR are yeast infections in women, urinary tract infections, increased urination, diarrhea, nausea, vomiting, flatulence, abdominal discomfort, muscle weakness, indigestion, and headache. Serious side effects include lactic acidosis, which can lead to death. People with kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Invokamet or Invokamet XR should not take Invokamet or Invokamet XR. Kidney function should be tested prior to starting treatment with Invokamet or Invokamet XR.

What are Janumet (sitagliptin and metformin HCl) & Janumet XR (sitagliptin and metformin HCl extended-release)?

Janumet and Janumet XR are used in combination with diet and exercise to improve glycemic (blood sugar) control in people with type 2 diabetes. Janumet is a combination of sitagliptin (a DPP-4 inhibitor) and metformin. Janumet XR combines sitagliptin with an extended-release formulation of metformin. As a DPP-4 inhibitor, sitagliptin works on the incretin hormones to increase the amount of insulin produced by the pancreas. Metformin reduces the amount of glucose produced by the liver. Janumet comes in a tablet that is taken twice daily with meals. Janumet XR is taken once daily, usually with the evening meal. Some of the most common side effects experienced by people taking Janumet and Janumet XR are diarrhea, upper respiratory tract infections, headache, and low blood sugar. Rarely, people taking Janumet and Janumet XR experience lactic acidosis, which may lead to death. Some people should not take Janumet and Janumet XR, including those with severe kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Janumet or Janumet XR. Prior to starting treatment with Janumet or Janumet XR, people should have their kidney function evaluated.

What are Jentadueto (linagliptin and metformin HCl) & Jentadueto XR (linagliptin and metformin HCl extended-release)?

Jentadueto combines a DPP-4 inhibitor, linagliptin, and a biguanide, metformin. Jentadueto XR is a mixture of linagliptin and an extended-release formulation of metformin. Both Jentadueto and Jentadueto XR are used in combination with diet and exercise to improve glycemic control in people with type 2 diabetes. Linagliptin works to increase incretin hormones which ultimately increases the amount of insulin produced by the body and also decreases the amount of glucagon (a hormone that raises blood sugar) that is produced by the body. Metformin reduces the amount of glucose produced by the liver. Both Jentadueto and Jentadueto XR come in a tablet formulation. Jentadueto is taken twice daily with meals, while Jentadueto XR is taken once daily with a meal. Some of the most common side effects experienced by people taking Jentadueto and Jentadueto XR are colds, diarrhea, and low blood sugar. Rarely, people taking Jentadueto and Jentadueto XR have experienced lactic acidosis, and this is more common in people with kidney impairment or those over the age of 65. People with severe kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or an allergy to any of the ingredients in Jentadueto or Jentadueto XR should not take these medications. Before beginning treatment with Jentadueto and Jentadueto XR, people should have their kidney function tested. Jentadueto and Jentadueto XR should be discontinued if a person is undergoing radiologic testing involving iodinated contrast materials, talk with your physician about this.

What is Metaglip (glipizide and metformin HCl)?

Metaglip contains two drugs that work on controlling blood sugar: glipizide and metformin. Glipizide is a sulfonylurea that stimulates the release of insulin from the pancreas, and metformin reduces the amount of glucose produced by the liver. Metaglip is used in combination with diet and exercise to help people with type 2 diabetes manage their blood sugar. It is generally prescribed for people whose blood sugar has not been adequately controlled by either glipizide or metformin alone. Metaglip comes in a tablet that is taken twice daily with morning and evening meals. Some of the most common side effects associated with Metaglip are upper respiratory tract infections, diarrhea, headache, dizziness, nausea, and vomiting. People with kidney disease or kidney impairment, a known allergy to any of the ingredients in Metaglip, or acute or chronic metabolic acidosis (including diabetic ketoacidosis) should not take Metaglip. Metaglip should be discontinued when a person is undergoing radiologic testing involving iodinated contrast materials. Kidney function should be tested prior to starting therapy with this medication.

What is Oseni (alogliptin and pioglitazone)?

Oseni combines a DPP-4 inhibitor (alogliptin) and a thiazolidinedione (pioglitazone). It is used in addition to diet and exercise to help people with type 2 diabetes improve their glycemic control. Alogliptin helps manage blood sugar by slowing the inactivation of incretin hormones, thus increasing the amount of insulin produced by the pancreas. Pioglitazone works by increasing the body’s sensitivity to insulin. Oseni comes in a tablet that is taken once daily, with or without food. Some of the most common side effects experienced by patients taking Oseni are colds, upper respiratory tract infections, and back pain. Some people should not take Oseni, including those with heart failure or who have a known allergy to any ingredient in Oseni. Oseni may cause or worsen congestive heart failure in some patients.

What is PrandiMet (repaglinide and metformin HCl)?

PrandiMet is a combination of repaglinide (a meglitinide) and metformin (a biguanide) used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes. PrandiMet is used in people who are already taking a meglitinide and metformin or those whose blood sugar is not adequately controlled by a meglitinide or metformin alone. Repaglinide stimulates the release of insulin from the pancreas, while metformin decreases the amount of glucose produced by the liver. PrandiMet is a tablet that is taken twice daily, just prior to meals. Some of the most common side effects associated with PrandiMet are low blood sugar, headache, diarrhea, nausea, and vomiting. Some people taking PrandiMet have developed lactic acidosis. The risk of lactic acidosis is higher among people with sepsis, dehydration, excessive alcohol intake, liver impairment, kidney impairment, and acute congestive heart failure. Kidney function should be assessed prior to starting therapy. People with kidney impairment, metabolic acidosis (including diabetic ketoacidosis), or who are receiving gemfibrozil should not take PrandiMet.

What is Qtern (dapagliflozin and saxagliptin)?

Qtern is a once-daily oral medication that is used in combination with diet and exercise to help people with type 2 diabetes manage their blood sugar. Qtern contains two medications: dapagliflozin and saxagliptin. Dapagliflozin is marketed as Farxiga and is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor. SGLT-2 inhibitors work by stopping the reabsorption of glucose from the kidneys so that more of the glucose in the body is excreted in the urine. Saxagliptin is marketed as Onglyza and is a dipeptidyl peptidase-4 (DPP-4) inhibitor. It works by increasing the amount of insulin produced by the body after meals when blood sugar is high and decreasing the amount of glucagon (a hormone that raises blood sugar) that is produced by the body. The most common side effects experienced by people taking Qtern are upper respiratory infection, urinary tract infection, and dyslipidemia (an elevation of cholesterol and/or fats (lipids) in the blood). Qtern should not be used in people with severe kidney impairment, end-stage renal (kidney) disease, patients on dialysis and those who have a known allergy to any of the ingredients in Qtern.

What is SOLIQUA 100/33 (insulin glargine/lixisenatide)?

SOLIQUA 100/33 is a combination of a long-acting human insulin analog (insulin glargine) and a glucagon-like peptide-1 (GLP-1) receptor agonist (lixisenatide). SOLIQUA 100/33 is used in addition to diet and exercise to improve glycemic control in people with type 2 diabetes whose blood sugar is not adequately controlled on basal insulin or lixisenatide. SOLIQUA 100/33 comes in a single-patient use pen and is injected once a day within the hour prior to the first meal of the day. The injection should be given in the thigh, upper arm, or abdomen. Some of the most common side effects experienced by patients taking SOLIQUA 100/33 are hypoglycemia, allergic reactions, nausea, colds, diarrhea, upper respiratory tract infections, and headache. SOLIQUA 100/33 should not be used during periods of hypoglycemia and should not be used by anyone who is allergic to any of its ingredients.

What are Synjardy (empagliflozin/metformin HCl) and Synjardy XR (empagliflozin/metformin HCl extended-release)?

Synjardy is a combination of empagliflozin and metformin. It also comes in an extended-release formulation, Synjardy XR. Empagliflozin is a SGLT2 inhibitor and works by preventing the kidneys from reabsorbing glucose and increases the amount of glucose excreted through the urine. Metformin is a biguanide, which helps control blood sugar by reducing the amount of glucose produced by the liver. Synjardy and Synjardy XR may be prescribed for people with type 2 diabetes who have previously tried treatment with metformin or empagliflozin alone and who still have problems with controlling their blood sugar. Synjardy and Synjardy XR are used in combination with diet and exercise to improve blood sugar control. Synjardy comes in a tablet that is taken twice daily with meals, and Synjardy XR comes in a tablet that is taken once daily with the morning meal. Some of the most common side effects experienced by patients taking Synjardy and Synjardy XR are urinary tract infection, fungal infections in women, diarrhea, nausea, vomiting, flatulence (passing gas), abdominal discomfort, indigestion, physical weakness, and headache. Rarely, serious side effects may occur with Synjardy or Synjardy XR, including lactic acidosis, which can lead to death. People with kidney disease or impairment, acute or chronic metabolic acidosis (including diabetic ketoacidosis), or a known allergy to any of the ingredients in Synjardy or Synjardy XR should not take Synjardy or Synjardy XR. Patient kidney function should be assessed prior to starting therapy.

What is Xigduo XR (dapagliflozin/metformin HCl extended-release)?

Xigduo XR is a combination of dapagliflozin and metformin. It is an extended-release formulation which allows for a slower, steady release of medication throughout the day. Dapagliflozin is a SGLT2 inhibitor, which works by preventing the kidneys from reabsorbing glucose. Metformin helps control blood sugar by reducing the amount of glucose produced by the liver. Xigduo XR comes in a tablet that is taken by mouth once in the morning with food. Some of the most common side effects experienced by patients taking Xigduo XR are urinary tract infections, fungal infections in women, diarrhea, respiratory infections, and headache. People with kidney disease or impairment, acute or chronic metabolic acidosis (including diabetic ketoacidosis), or a known allergy to any of the ingredients in Xigduo XR should not take Xigduo XR. Kidney function should be assessed before starting therapy with Xigduo XR.

What is Xultophy 100/3.6 (insulin degludec and liraglutide injection)?

Xultophy combines a long-acting human insulin analog (insulin degludec) and a GLP-1 receptor agonist (liraglutide). It is used in addition to diet and exercise to improve glycemic control in people with type 2 diabetes whose blood sugar is not adequately controlled on basal insulin or liraglutide. Xultophy comes in a single-patient use pen and is injected once daily in the thigh, upper arm, or abdomen. Some of the most common side effects experienced by patients taking Xultophy are colds, headaches, nausea, diarrhea, increased lipase (a liver enzyme), and upper respiratory tract infections. Xultophy should not be used during periods of hypoglycemia. People who have multiple endocrine neoplasia syndrome, a family history of medullary thyroid cancer, or a known allergy to any of the ingredients in Xultophy should not use Xultophy.

Written by: Emily Downward | Last reviewed: April 2017
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