From the FDA Drug Label
In one monotherapy trial, a total of 558 treatment-naive patients with inadequately controlled diabetes participated in a 24-week trial (NCT00528372) Following a 2-week diet and exercise placebo lead-in period, 485 patients with HbA1c ≥7% and ≤10% were randomized to dapagliflozin 5 mg or dapagliflozin 10 mg once daily in either the morning (QAM, main cohort) or evening (QPM), or placebo At Week 24, treatment with dapagliflozin 10 mg QAM provided significant improvements in HbA1c and the fasting plasma glucose (FPG) compared with placebo
The optimal timing for taking Farxiga (dapagliflozin) 10mg is in the morning (QAM). For glimepiride, the label does not specify the optimal timing. It is recommended to take metformin 2g twice daily as prescribed. Key points:
- Dapagliflozin 10mg should be taken in the morning.
- Glimepiride timing is not specified in the label.
- Metformin should be taken as prescribed, 2g twice daily 1
From the Research
For optimal glycemic control, I recommend taking Farxiga (dapagliflozin) 10 mg in the morning and glimepiride in the morning with breakfast. Glimepiride should be started at a low dose (typically 1-2 mg) and titrated based on blood glucose response. Continue metformin at 1000 mg twice daily as currently prescribed. This timing strategy maximizes the complementary effects of these medications throughout the day. Farxiga works by increasing urinary glucose excretion and is most effective when taken in the morning to address daytime hyperglycemia. Glimepiride, a sulfonylurea, stimulates insulin secretion and works best when taken with the first meal of the day to target morning hyperglycemia. Taking glimepiride in the morning reduces the risk of nocturnal hypoglycemia that could occur with evening dosing, as supported by studies such as 2 which showed that morning administration of similar medications can lead to better glycemic control and reduced risk of nocturnal hypoglycemia. Monitor for hypoglycemia, especially during the first few weeks after adding glimepiride, and ensure adequate hydration while on Farxiga. Regular blood glucose monitoring is essential to evaluate the effectiveness of this regimen and guide any necessary adjustments, considering the patient's response and potential side effects as discussed in studies like 3 and 4.
Some key points to consider in this regimen include:
- The importance of starting glimepiride at a low dose and titrating based on response to minimize the risk of hypoglycemia.
- The complementary mechanisms of action of Farxiga, glimepiride, and metformin, which work together to improve glycemic control, as discussed in 4.
- The need for regular monitoring and potential adjustments to the regimen based on the patient's response and side effects, as highlighted in studies such as 5 and 6.
- The potential benefits of this regimen in reducing the risk of nocturnal hypoglycemia and improving overall glycemic control, as supported by the evidence from 2 and 3.
Overall, this regimen is designed to provide optimal glycemic control while minimizing the risk of side effects, based on the evidence from studies such as 2, 5, 6, 3, and 4.