From the Guidelines
Yes, furosemide 40mg/day and dapagliflozin 10mg/day can typically be restarted for Congestive Heart Failure treatment. These medications work through complementary mechanisms to reduce fluid overload and improve heart function. Furosemide is a loop diuretic that increases urine output by inhibiting sodium and chloride reabsorption in the kidneys, while dapagliflozin is an SGLT2 inhibitor that promotes glucose excretion in urine and has been shown to reduce heart failure hospitalizations and cardiovascular mortality, as seen in the DAPA-HF trial 1.
When restarting these medications, monitor for potential side effects including dehydration, electrolyte imbalances (particularly potassium), hypotension, and renal function changes. Regular assessment of blood pressure, kidney function, and electrolytes is recommended, especially in the first few weeks after restarting therapy, as suggested by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. Patients should be advised to maintain adequate hydration while avoiding excessive fluid intake, monitor their weight daily, and report symptoms such as dizziness, unusual fatigue, or significant changes in urination patterns.
The 2024 ESC guidelines for the management of chronic coronary syndromes also recommend the use of SGLT2 inhibitors, such as dapagliflozin, in patients with heart failure to reduce the risk of hospitalization and cardiovascular death 1. Dose adjustments may be necessary based on individual response and tolerance. It is essential to consider the patient's overall clinical context, including their kidney function, blood pressure, and potential interactions with other medications, when restarting furosemide and dapagliflozin.
Key considerations for restarting these medications include:
- Monitoring for signs of dehydration and electrolyte imbalances
- Regular assessment of kidney function and blood pressure
- Patient education on maintaining adequate hydration and monitoring for adverse effects
- Potential dose adjustments based on individual response and tolerance
- Consideration of the patient's overall clinical context, including kidney function and potential interactions with other medications.
From the FDA Drug Label
To reduce the risk of CV death, hHF, and urgent heart failure visit in patients with heart failure. The recommended dosage of DAPAGLIFLOZIN TABLETS is 10 mg orally once daily in adults for the following indications: • To reduce the risk of sustained eGFR decline, end stage kidney disease (ESKD), cardiovascular (CV) death, and hospitalization for heart failure (hHF) in patients with chronic kidney disease at risk of progression • To reduce the risk of CV death, hHF, and urgent heart failure visit in patients with heart failure.
The combination of furosemide 40mg/day and dapagliflozin 10mg/day can be used for Congestive Heart Failure (CHF) treatment.
- Dapagliflozin 10mg/day is recommended for adults with heart failure to reduce the risk of CV death, hHF, and urgent heart failure visit.
- However, it is crucial to assess renal function and volume status before initiating dapagliflozin and to correct any volume depletion before starting treatment 2.
- The use of furosemide, a loop diuretic, may help manage volume overload in patients with CHF, but its combination with dapagliflozin should be carefully monitored due to the potential risk of dehydration and electrolyte imbalance.
From the Research
Furosemide and Dapagliflozin for CHF Treatment
- Furosemide 40mg/day and dapagliflozin 10mg/day can be considered for Congestive Heart Failure (CHF) treatment, as supported by studies 3, 4, 5, 6.
- The combination of furosemide and dapagliflozin has been shown to improve symptoms and reduce the risk of worsening heart failure in patients with CHF 3, 4.
- Dapagliflozin has been found to be effective in reducing the risk of cardiovascular death or hospitalization for heart failure, regardless of the presence or absence of type 2 diabetes 5, 6.
Efficacy and Safety
- The efficacy and safety of dapagliflozin have been consistently demonstrated across various studies, including those with background diuretic treatment 4, 5, 6.
- Furosemide and dapagliflozin have been shown to have a favorable safety profile, with no significant changes in serum potassium or kidney functions 3.
- The combination of furosemide and dapagliflozin has been found to be well-tolerated, with improvements in patient-reported symptoms and physical limitations 7.
Clinical Considerations
- The use of furosemide and dapagliflozin for CHF treatment should be individualized, taking into account the patient's specific clinical characteristics and medical history 4, 5, 6.
- Regular monitoring of serum electrolytes, kidney functions, and patient symptoms is recommended when using furosemide and dapagliflozin for CHF treatment 3, 4.