Can a patient take Farxiga (dapagliflozin) and Mounjaro (tirzepatide) together?

Combining Farxiga (Dapagliflozin) and Mounjaro (Tirzepatide) for Diabetes Management

Yes, patients can safely take Farxiga (dapagliflozin) and Mounjaro (tirzepatide) together, and this combination may provide complementary benefits for glycemic control, weight management, and cardiorenal protection.

Rationale for Combination Therapy

The 2024 Diabetes, Cardiorenal, and Metabolic Diseases (DCRM) guidelines explicitly support combining GLP-1 receptor agonists (like tirzepatide) with SGLT2 inhibitors (like dapagliflozin) 1:

• These medication classes work through complementary mechanisms:

  • Tirzepatide (Mounjaro): Dual GIP/GLP-1 receptor agonist that improves insulin secretion, reduces glucagon, slows gastric emptying, and promotes weight loss
  • Dapagliflozin (Farxiga): SGLT2 inhibitor that increases urinary glucose excretion, reduces glucose reabsorption in kidneys, and provides cardiorenal protection

• The guidelines state: "Combining agents from these classes will be beneficial in many people" 1

Clinical Benefits of Combination

When used together, these medications provide several advantages:

1. Enhanced glycemic control: The combination provides more robust A1C reduction than either agent alone
2. Complementary weight loss effects: Both medications promote weight reduction through different mechanisms
3. Additive cardiorenal benefits:
   • Dapagliflozin reduces risk of heart failure, kidney disease progression, and cardiovascular events
   • Tirzepatide provides potent glucose lowering and weight reduction

Safety Considerations

While the combination is generally safe, clinicians should monitor for:

1. Hypoglycemia risk: Low risk with this specific combination, but monitor patients also taking insulin or sulfonylureas 1
2. Volume depletion: SGLT2 inhibitors can cause volume depletion; ensure adequate hydration
3. Genital mycotic infections: More common with SGLT2 inhibitors; counsel on hygiene 1
4. Gastrointestinal effects: Nausea, vomiting, and diarrhea more common with tirzepatide; typically improve over time

Perioperative Considerations

For patients undergoing surgery while on this combination:

• The 2025 anesthesia consensus statement recommends careful perioperative management due to potential effects on gastric emptying with tirzepatide 1
• Consider timing of medication administration relative to surgical procedures

Monitoring Recommendations

When initiating this combination:

1. Renal function: Monitor eGFR, particularly when starting dapagliflozin
2. Blood pressure: Both medications may reduce blood pressure
3. Weight: Track weight changes to assess efficacy
4. Glycemic parameters: Monitor for improved control and adjust other diabetes medications as needed

Clinical Pearls

• Dosing sequence: Consider initiating one agent first, stabilizing the patient, then adding the second medication to minimize side effects
• Hydration: Emphasize adequate fluid intake to prevent volume depletion
• Cost considerations: This combination may be expensive; check insurance coverage
• Medication interactions: No significant pharmacokinetic interactions between these specific agents

The combination of Farxiga and Mounjaro represents a modern approach to diabetes management that addresses multiple pathophysiological aspects of the disease while providing additional cardiorenal protection.