Direct Dose Conversion: Jardiance to Farxiga
When switching from Jardiance (empagliflozin) to Farxiga (dapagliflozin), use Jardiance 10 mg → Farxiga 10 mg, or Jardiance 25 mg → Farxiga 10 mg. Both doses of empagliflozin convert to the standard 10 mg dose of dapagliflozin, as this is the maximum approved dose for cardiovascular and renal benefits 1, 2.
Dosing Equivalence
The FDA-approved dosing differs between these agents:
- Jardiance: 10 mg or 25 mg once daily 1
- Farxiga: 10 mg once daily (maximum dose for all indications) 2
There is no 1:1 dose equivalence between these medications. Farxiga 10 mg is the therapeutic dose regardless of whether the patient was on Jardiance 10 mg or 25 mg. The pharmacodynamic data shows that dapagliflozin achieves near-maximum glucose excretion (~70 grams/day) at 10 mg, with minimal additional benefit at higher doses 2.
Practical Switching Protocol
Simply discontinue Jardiance and start Farxiga 10 mg the next morning. Both medications:
- Are taken once daily in the morning
- Can be administered with or without food
- Have similar onset of action (2 hours to peak concentration)
- Have comparable half-lives (12.9 hours for dapagliflozin vs. similar for empagliflozin) 1, 2
No washout period or dose titration is required. The switch can be made immediately without overlap or gap in therapy.
Renal Function Considerations
Critical: Verify eGFR before switching. Both agents have identical initiation thresholds:
- Do not initiate if eGFR < 45 mL/min/1.73 m² 1
- Continue for cardiovascular/renal benefits even when eGFR < 45 mL/min/1.73 m² if already established on therapy 3
- Discontinue only at dialysis or transplantation 3
The glucose-lowering effect diminishes below eGFR 45 mL/min/1.73 m², but cardiorenal protective benefits persist, which is why continuation is recommended in established users 3, 4.
Expected Clinical Differences
While both are SGLT2 inhibitors with similar mechanisms, empagliflozin may provide slightly greater glycemic control:
- Empagliflozin showed greater HbA1c reduction (-1.7% vs -1.2%, p=0.002) and FBS reduction in head-to-head studies 5, 6
- However, dapagliflozin demonstrated superior cardiovascular outcomes in recent real-world data, with lower MACE (adjusted OR 0.46) and heart failure hospitalizations in HFrEF patients 7
- Dapagliflozin achieved greater total cholesterol reduction in post-CABG heart failure patients 8
For diabetes management alone, expect comparable but potentially slightly less glycemic control with dapagliflozin. For heart failure or CKD indications, outcomes appear equivalent or potentially favorable with dapagliflozin 7, 9.
Safety Monitoring After Switch
Monitor for the same adverse effects with both agents 3:
- Genital mycotic infections: Slightly lower risk with empagliflozin (3.1% vs 8.7%) 5, but counsel on genital hygiene regardless
- Volume depletion: Check blood pressure and adjust diuretics if needed
- DKA risk: Rare in type 2 diabetes, but provide sick-day planning (discontinue during illness, surgery, prolonged fasting)
- Renal function: Recheck within 2-4 weeks, expect transient creatinine increase up to 30% (acceptable and reversible) 4
Special caution with linezolid: If patient requires linezolid, dapagliflozin carries risk of severe pancytopenia requiring hematologic monitoring 10.
Common Pitfalls to Avoid
- Do not attempt to "match" doses numerically - Farxiga only comes in 5 mg and 10 mg, with 10 mg being the standard therapeutic dose
- Do not discontinue if eGFR drops below 45 mL/min/1.73 m² after initiation - continue for cardiorenal benefits 3, 4
- Do not assume identical efficacy - while both are SGLT2 inhibitors, emerging evidence suggests nuanced differences in cardiovascular outcomes 7
- Do not forget to discontinue 3-4 days before scheduled surgery to minimize DKA risk 3
The switch is straightforward from a dosing perspective: Farxiga 10 mg replaces any dose of Jardiance, with immediate transition and no titration required.