From the Guidelines
Farxiga (dapagliflozin) is typically prescribed at a starting dose of 5 mg once daily, taken in the morning with or without food, and can be increased to a maximum of 10 mg once daily for patients with type 2 diabetes, heart failure, or chronic kidney disease, as recommended by the most recent guidelines 1.
Key Considerations
- For patients who tolerate the initial dose well and need additional glycemic control, the dose can be increased to the maximum of 10 mg once daily.
- For patients with type 2 diabetes, either dose is appropriate, while for heart failure or chronic kidney disease, 10 mg daily is the recommended dose.
- Patients with severe hepatic impairment should start with 5 mg and be monitored closely.
- Farxiga should not be used in patients with eGFR less than 25 mL/min/1.73m² due to reduced effectiveness, as stated in the guidelines 1.
Mechanism of Action and Side Effects
- The medication works by inhibiting sodium-glucose cotransporter 2 (SGLT2) in the kidneys, which increases glucose excretion in urine and reduces blood glucose levels.
- Patients should be advised to maintain adequate hydration while taking Farxiga and monitor for side effects such as genital mycotic infections, urinary tract infections, and hypotension, especially when starting treatment, as warned by recent studies 1.
Special Populations
- The guidelines recommend using Farxiga with caution in patients with kidney disease, and dose adjustments may be necessary based on eGFR levels, as outlined in the consensus report 1.
- Patients with heart failure may benefit from the use of Farxiga, as it has been shown to reduce the risk of worsening heart failure and cardiovascular death, according to recent trials 1.
From the FDA Drug Label
To improve glycemic control, the recommended starting dosage is 5 mg orally once daily. Dosage can be increased to 10 mg orally once daily for additional glycemic control. For all other indications, the recommended dosage is 10 mg orally once daily. The dosing options for Farxiga are:
- 5 mg orally once daily as the starting dose to improve glycemic control
- 10 mg orally once daily for additional glycemic control or for other indications such as reducing the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure 2 2
From the Research
Farxiga Dosing Options
- The dosing options for Farxiga (dapagliflozin) are not explicitly stated in the provided studies, but its usage as monotherapy or combination therapy is discussed 3, 4, 5.
- Dapagliflozin is approved for use as monotherapy in patients with type 2 diabetes who are intolerant of metformin, and as add-on combination therapy with other glucose-lowering agents, including insulin 3.
- The drug is generally well tolerated, with a low risk of hypoglycaemia, but may cause genital and lower urinary tract infections, which are usually mild to moderate and respond to standard antimicrobial treatment 3, 5.
Administration and Usage
- Dapagliflozin is administered orally, once daily 3.
- It is used in the treatment of type 2 diabetes mellitus, and has been shown to provide effective glycaemic control, reduce body weight and blood pressure, and have cardioprotective and possibly renoprotective properties 3, 4, 6, 7.
- The drug has been found to be beneficial in patients with cardiovascular and chronic kidney disease, and its usage in these patients is likely to increase 4, 6, 7.
Special Considerations
- Dapagliflozin should not be prescribed in patients with moderate or severe renal impairment, or in patients at risk for developing volume depletion 5.
- The drug has been found to be effective in patients with heart failure and type 2 diabetes, with significant improvements in cardiac and renal function, and ambulatory capacity, without an increased risk of adverse effects or outcomes 7.