From the Guidelines
Farxiga (dapagliflozin) does not directly compromise the immune system, but it may increase the risk of certain infections such as urinary tract infections and genital mycotic infections, as noted in the 2025 guideline for the management of patients with acute coronary syndromes 1.
Key Points to Consider
- Farxiga is an SGLT2 inhibitor that works primarily in the kidneys by preventing glucose reabsorption, causing excess glucose to be excreted in urine.
- While not directly immunomodulatory, some research suggests Farxiga may have indirect effects on inflammation and immune function, potentially reducing certain inflammatory markers like C-reactive protein and pro-inflammatory cytokines in patients with diabetes and cardiovascular disease 1.
- The 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment notes that SGLT2 inhibitors, including dapagliflozin, may contribute to volume depletion and increase the risk of mycotic genital infections, urosepsis, and pyelonephritis 1.
- Patients should be aware of the potential risks and benefits of Farxiga and discuss any concerns with their healthcare provider, as the primary use of Farxiga is for type 2 diabetes management, heart failure, and chronic kidney disease.
Important Considerations for Healthcare Providers
- Monitor patients for signs and symptoms of urinary tract infections, genital mycotic infections, and other potential adverse effects.
- Temporarily discontinue Farxiga before scheduled surgery to avoid potential risk for ketoacidosis, as recommended in the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1.
- Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level.
From the Research
Farxiga and the Immune System
- Farxiga (dapagliflozin) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor used to treat type 2 diabetes mellitus.
- The use of SGLT2 inhibitors, including Farxiga, has been associated with an increased risk of genital fungal infections and urinary tract infections (UTIs) 2, 3, 4, 5, 6.
- Studies have shown that women and patients with a prior history of genital fungal infections are at a higher risk of developing genital fungal infections while taking Farxiga 2.
- The increased risk of UTIs and genital fungal infections with SGLT2 inhibitors is thought to be related to the mechanism of action of these drugs, which increases glucose excretion in the urine, creating a favorable environment for the growth of microorganisms 3, 6.
- However, most reported infections are mild to moderate and respond to standard treatment 2, 3, 4, 5, 6.
Risk Factors for Infections
- Patient sex: Women are at a higher risk of developing genital fungal infections while taking Farxiga 2.
- Prior history of genital fungal infections: Patients with a prior history of genital fungal infections are at a higher risk of developing genital fungal infections while taking Farxiga 2.
- Diabetes duration: The risk of UTIs and genital fungal infections may be higher in patients with a longer duration of diabetes 3.
- Renal function: The pharmacodynamic response to Farxiga declines with increasing severity of renal impairment, which may affect the risk of UTIs and genital fungal infections 5.