Can Farxiga (dapagliflozin) cause hypoglycemia?

From the Guidelines

Farxiga (dapagliflozin) typically does not cause hypoglycemia when used alone. As an SGLT2 inhibitor, Farxiga works by preventing the kidneys from reabsorbing glucose, allowing it to be excreted in urine, which lowers blood sugar without stimulating insulin production 1. However, when Farxiga is combined with insulin or insulin secretagogues like sulfonylureas, the risk of hypoglycemia increases significantly. Patients taking these combination therapies should monitor their blood glucose levels regularly and be aware of hypoglycemia symptoms such as shakiness, dizziness, confusion, and sweating. If hypoglycemia occurs, it should be treated promptly with fast-acting carbohydrates like glucose tablets or juice.

The risk of hypoglycemia with Farxiga is also higher in elderly patients, those with kidney impairment, and during periods of reduced caloric intake, increased physical activity, or alcohol consumption. Understanding this mechanism helps explain why Farxiga alone rarely causes blood sugar to drop too low, unlike medications that directly increase insulin levels. According to the most recent guidelines, SGLT2 inhibitors, including Farxiga, do not increase the risk of hypoglycemia when used alone 1. However, it is essential to consider the individual patient's characteristics, such as kidney function and concomitant medications, when prescribing Farxiga to minimize the risk of hypoglycemia and other adverse effects.

Some key points to consider when prescribing Farxiga include:

• Monitoring blood glucose levels regularly, especially when combined with insulin or insulin secretagogues
• Being aware of hypoglycemia symptoms and treating promptly with fast-acting carbohydrates
• Considering the individual patient's characteristics, such as kidney function and concomitant medications
• Adjusting background therapies, such as insulin or sulfonylureas, as necessary to minimize the risk of hypoglycemia 1.

Overall, Farxiga is a safe and effective treatment option for patients with type 2 diabetes, with a low risk of hypoglycemia when used alone. However, it is crucial to carefully consider the individual patient's needs and circumstances to minimize the risk of adverse effects and optimize treatment outcomes.

From the FDA Drug Label

• Hypoglycemia: Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with DAPAGLIFLOZIN TABLETS. (5. 4)

5.4 Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues Insulin and insulin secretagogues (e.g., sulfonylureas) are known to cause hypoglycemia. DAPAGLIFLOZIN TABLETS may increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue [see Adverse Reactions (6. 1)].

Hypoglycemia Risk: Dapagliflozin may increase the risk of hypoglycemia when used in combination with insulin or an insulin secretagogue. To minimize this risk, a lower dose of insulin or insulin secretagogue may be required 2, 2.

• Key Points:
  • Dapagliflozin may increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue.
  • A lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia.

From the Research

Farxiga and Hypoglycemia

• Farxiga (dapagliflozin) has a low risk of hypoglycemia, as stated in studies 3, 4, 5, 6.
• The mechanism of action of dapagliflozin is independent of insulin secretion or action, which contributes to its low risk of hypoglycemia 3, 6.
• Clinical trials have shown that dapagliflozin can provide effective glycemic control without a significant risk of hypoglycemia 4, 5, 6.
• In comparison to other antidiabetic drugs, such as glipizide, dapagliflozin has been shown to produce less hypoglycemia 7.
• The incidence of hypoglycemia with dapagliflozin may vary depending on the background therapy used in combination with the drug 3.

Key Findings

• Dapagliflozin reduces renal glucose reabsorption, increasing urinary glucose excretion and reducing blood glucose levels 3, 5, 6.
• The drug has been shown to be generally well-tolerated, with common adverse events including genital mycotic infections and urinary tract infections 3, 4, 6.
• Dapagliflozin is not recommended for patients with moderate or severe renal impairment 3.

Comparison to Other Treatments

• Dapagliflozin has been compared to other SGLT-2 inhibitors, such as empagliflozin and canagliflozin, and has shown potential superiority in preventing heart failure 5.
• In a study comparing dapagliflozin to glipizide, dapagliflozin produced significant weight loss and reduced the proportion of patients experiencing hypoglycemia 7.