Farxiga Drug Class: SGLT2 Inhibitors
Farxiga (dapagliflozin) belongs to the SGLT2 inhibitor class (sodium-glucose cotransporter-2 inhibitors), also known as gliflozins. 1
Other Drugs in the Same Class
The SGLT2 inhibitor class includes the following FDA-approved medications:
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
- Canagliflozin (Invokana)
- Ertugliflozin (Steglatro)
- Bexagliflozin
Special Consideration: Sotagliflozin
Sotagliflozin is a dual SGLT1/SGLT2 inhibitor, which distinguishes it from the pure SGLT2 inhibitors listed above. While it inhibits SGLT2 like the others, it also blocks SGLT1 in the gut, delaying glucose absorption. Notably, sotagliflozin is FDA-approved for heart failure indications but not currently approved for glycemic management of diabetes. 5
Mechanism of Action
All SGLT2 inhibitors work by blocking the SGLT2 protein in the proximal tubule of the kidney, which normally reabsorbs approximately 90% of filtered glucose. By inhibiting this reabsorption, these medications increase urinary glucose excretion, thereby lowering blood glucose levels. 2, 6
Key Clinical Effects (Class Effects)
Glycemic Control:
- HbA1c reduction of 0.4-1% across the class 2
Cardiovascular Benefits:
- Reduction in major adverse cardiovascular events (MACE) with empagliflozin, canagliflozin, and dapagliflozin 6, 4
- Significant reduction in heart failure hospitalization across all agents 5, 4
Renal Protection:
- All SGLT2 inhibitors demonstrate kidney protective effects, with canagliflozin, empagliflozin, and dapagliflozin having specific FDA indications for chronic kidney disease 4, 7
Additional Effects:
- Weight loss (intermediate effect, typically 2-3% of body weight) 8, 9
- Blood pressure reduction 6
- Low hypoglycemia risk when used alone 2, 6
Important Safety Considerations
Common adverse effects across the class include:
- Genital mycotic infections (most common)
- Urinary tract infections
- Increased urination and volume depletion 4, 9
Serious but rare risks:
- Diabetic ketoacidosis (including euglycemic DKA) - discontinue 3-4 days before surgery 4, 9
- Necrotizing fasciitis of the perineum (Fournier's gangrene) 9
- Acute kidney injury secondary to volume depletion 1
The class demonstrates remarkable consistency in both efficacy and safety profiles, making them interchangeable for most indications, though individual agents have specific FDA approvals for different cardiovascular and renal conditions based on their respective outcome trials.