What is the recommended use and dosing of Farxiga (dapagliflozin) for patients with type 2 diabetes or heart failure?

From the Guidelines

Farxiga (dapagliflozin) should be prescribed at a dose of 10 mg once daily for patients with type 2 diabetes and heart failure, particularly those with reduced ejection fraction, as it has been shown to reduce the risk of worsening heart failure and cardiovascular death 1. The medication should be taken with or without food and at approximately the same time each day for consistent results. Patients with kidney impairment require dose adjustments; Farxiga is not recommended for those with eGFR less than 45 mL/min/1.73m² for diabetes treatment, though it can be used in heart failure patients with eGFR as low as 25 mL/min/1.73m² 2, 3, 4. Some key points to consider when prescribing Farxiga include:

• The medication works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which increases glucose excretion in urine, thereby lowering blood sugar levels.
• In heart failure, it provides benefits beyond glucose control by reducing cardiac workload, decreasing fluid overload, and improving heart function.
• Patients should be monitored for potential side effects including genital mycotic infections, urinary tract infections, and volume depletion, especially when initiating therapy.
• The use of SGLT inhibitors increases the susceptibility to diabetic ketoacidosis, particularly when other risk factors or situations occur, such as insulin pump malfunctions, significant reduction in insulin doses, and nutritional intake plans with prolonged periods of fasting or carbohydrate restriction 1. It is essential to weigh the benefits and risks of Farxiga in each patient, considering their individual characteristics, such as kidney function and diabetes status, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

To reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression To reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure. To reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus.

The recommended use and dosing of Farxiga (dapagliflozin) for patients with type 2 diabetes or heart failure are as follows:

• Type 2 Diabetes: The recommended starting dosage is 5 mg orally once daily to improve glycemic control. For additional glycemic control, the dosage can be increased to 10 mg orally once daily.
• Heart Failure: The recommended dosage is 10 mg orally once daily in adults to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit.
• Renal Impairment: + For patients with an eGFR greater than or equal to 45 mL/min/1.73 m2, the recommended dosage is the same as the recommended dosage in patients with normal renal function. + For patients with an eGFR less than 45 mL/min/1.73 m2, Farxiga is not recommended for use to improve glycemic control. + For patients with an eGFR greater than or equal to 25 mL/min/1.73 m2, the recommended dosage is the same as the recommended dosage in patients with normal renal function. + Initiation with Farxiga is not recommended in patients with an eGFR less than 25 mL/min/1.73 m2. 5

From the Research

Recommended Use of Farxiga (Dapagliflozin)

• Farxiga (dapagliflozin) is indicated for the treatment of type 2 diabetes, heart failure with reduced ejection fraction, and chronic kidney disease 6, 7, 8.
• It can be used as monotherapy or in combination with other glucose-lowering agents, including insulin, for the treatment of type 2 diabetes 6, 9.
• For patients with heart failure with reduced ejection fraction, dapagliflozin can be used in addition to standard of care to reduce the risk of worsening heart failure or cardiovascular death 7.

Dosing of Farxiga (Dapagliflozin)

• The recommended dose of dapagliflozin for type 2 diabetes is 10 mg once daily 6, 9.
• The same dose of 10 mg once daily is recommended for heart failure with reduced ejection fraction, regardless of the presence or absence of type 2 diabetes 7.
• Dapagliflozin should be taken orally, once daily, with or without food 8.

Special Considerations

• Dapagliflozin is not recommended in patients with moderate or severe renal impairment, type 1 diabetes, or end-stage chronic kidney disease 9, 8.
• Patients with a history of cardiovascular disease or multiple risk factors for cardiovascular disease may benefit from the cardioprotective effects of dapagliflozin 6, 7.
• The risk of genital infections, urinary tract infections, and Fournier's gangrene is increased with dapagliflozin, and patients should be monitored for these adverse effects 9, 8, 10.