Short answer: Both pair an SGLT2 inhibitor with metformin.12 Synjardy uses empagliflozin and comes as a twice-daily tablet or once-daily Synjardy XR. Xigduo XR uses dapagliflozin and is a once-daily extended-release tablet taken in the morning. Both are approved from age 10 for blood sugar, carry heart and kidney uses in certain adults, and have a lactic acidosis boxed warning. Neither label reports a trial against the other.
| Synjardy | Xigduo XR | |
|---|---|---|
| Paired with metformin | Empagliflozin1 | Dapagliflozin2 |
| How taken | Synjardy twice daily with meals; Synjardy XR once daily with a morning meal1 | Once daily in the morning with food, swallowed whole2 |
| Maximum daily dose | Empagliflozin 25 mg and metformin 2,000 mg1 | Dapagliflozin 10 mg and metformin 2,000 mg2 |
| Other uses in adults with type 2 diabetes | Heart death in established heart disease, heart death and hospital stays in heart failure, kidney decline in chronic kidney disease1 | Kidney decline and heart events in chronic kidney disease, heart death and heart failure events in heart failure, heart failure hospital stays with heart disease or several risk factors2 |
| Kidney limits | Not used with an eGFR below 30; starting not recommended below 451 | Not used with an eGFR below 30; starting not recommended at 30 to 452 |
| Side effects in label trials | Added to metformin and a sulfonylurea: urinary tract infection 9.4% on 10 mg vs 6.7% on placebo1 | Pool of 8 trials with metformin: female genital yeast infection 9.3% on 10 mg vs 1.5% on placebo, urinary tract infection 5.5% vs 3.6%2 |
| Boxed warning | Lactic acidosis1 | Lactic acidosis2 |
Mostly. Both labels list lactic acidosis, ketoacidosis even with blood sugar below 250 mg/dL, fluid loss and low blood pressure, urinary and genital infections including Fournier's gangrene, low blood sugar with insulin or a sulfonylurea, and lower vitamin B12.12 The Synjardy label also lists lower limb amputation and serious allergic reactions.1 Both say to hold the tablet for at least 3 days, if possible, before surgery with long fasting.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Synjardy side effects, Xigduo XR side effects, the Synjardy and Xigduo XR dosing schedules, and Jardiance vs Farxiga: how do the two SGLT2 tablets compare?.