How should I switch a patient from Jardiance (empagliflozin) to Farxiga (dapagliflozin), including appropriate dosing and renal function considerations?

Switching from Jardiance to Farxiga

You can directly switch from Jardiance (empagliflozin) to Farxiga (dapagliflozin) without a washout period, using the appropriate dose based on the patient's eGFR and indication.

Dosing Strategy

For Type 2 Diabetes (Glycemic Control)

• If eGFR ≥45 mL/min/1.73 m²: Switch from any dose of Jardiance to Farxiga 10 mg once daily 1
• If eGFR 30-44 mL/min/1.73 m²: Farxiga 10 mg once daily is acceptable, though not recommended for initiation for glycemic control 2, 1
• If eGFR 25-29 mL/min/1.73 m²: Farxiga is not recommended for glycemic control but can be continued for cardiovascular/kidney benefits 1
• If eGFR <25 mL/min/1.73 m²: Do not initiate Farxiga, but may continue if already on therapy 1

For Heart Failure, CKD, or Cardiovascular Risk Reduction

• If eGFR ≥25 mL/min/1.73 m²: Switch to Farxiga 10 mg once daily 1
• If eGFR falls below 25 mL/min/1.73 m² while on treatment: Continue Farxiga 10 mg daily 1

Key Renal Function Considerations

The critical difference between these agents lies in their FDA-approved eGFR thresholds 2, 1, 3:

Jardiance (empagliflozin):

• Not recommended for initiation if eGFR <45 mL/min/1.73 m² for glycemic control
• Not recommended for use if eGFR <45 mL/min/1.73 m² per FDA label 3

Farxiga (dapagliflozin):

• Can be initiated down to eGFR 25 mL/min/1.73 m² for non-glycemic indications
• May be continued even if eGFR falls below 25 mL/min/1.73 m² 1

This makes Farxiga the preferred choice when eGFR is declining toward 45 mL/min/1.73 m², as it allows continuation of SGLT2 inhibitor therapy at lower kidney function levels 2, 4, 5.

Practical Switching Protocol

1. Check current eGFR before switching
2. Stop Jardiance and start Farxiga the next day at appropriate dose
3. No dose adjustments of other diabetes medications are typically needed 2
4. Monitor eGFR 2-4 weeks after switch (expect transient 2-3 mL/min/1.73 m² dip) 2
5. Reassess volume status if patient is on diuretics 2, 1

Clinical Equivalence

Both agents provide similar cardiovascular and kidney benefits 6, 7. A large Scandinavian cohort study of nearly 200,000 patients found no significant differences in major cardiovascular events (HR 1.02,95% CI 0.97-1.08), heart failure (HR 1.05,95% CI 0.97-1.14), or serious renal events (HR 0.97,95% CI 0.87-1.07) between empagliflozin and dapagliflozin 6. A 2025 Danish study similarly showed comparable kidney outcomes between the two agents 7.

Important Safety Considerations

Continue the same precautions as with Jardiance 2, 1:

• Withhold 3-4 days before major surgery
• Hold during acute illness or prolonged fasting
• Monitor for genital mycotic infections (6% incidence with SGLT2i)
• Watch for euglycemic DKA, especially in insulin-requiring patients
• Assess volume status, particularly if on loop diuretics

Common Pitfall to Avoid

Do not discontinue SGLT2 inhibitor therapy simply because eGFR falls below the initiation threshold. Both CREDENCE and DAPA-CKD trials demonstrated that continuing SGLT2 inhibitors as eGFR declines provides ongoing cardiovascular and kidney protection 2, 4. The acute eGFR dip of 2-3 mL/min/1.73 m² after initiation is hemodynamic, reversible, and does not indicate kidney injury 2.