Can Farxiga (dapagliflozin) cause pancreatitis?

Farxiga (Dapagliflozin) and Pancreatitis Risk

Yes, Farxiga (dapagliflozin) can cause pancreatitis, though it appears to be a rare adverse effect that is not prominently highlighted in current diabetes management guidelines. While pancreatitis is more commonly associated with other diabetes medications like GLP-1 receptor agonists, several case reports document pancreatitis occurring after initiation of SGLT2 inhibitors including dapagliflozin.

Evidence for Pancreatitis Risk with SGLT2 Inhibitors

• Multiple case reports have documented acute pancreatitis associated with SGLT2 inhibitors:

  • Dapagliflozin-associated acute pancreatitis has been reported in recent literature 1
  • Empagliflozin-associated pancreatitis has been documented in patients with no other risk factors 2, 3
  • Canagliflozin-induced pancreatitis has been reported as a rare side effect 4

• The 2025 Standards of Care in Diabetes mentions pancreatitis as a recognized adverse effect of GLP-1 receptor agonists but does not specifically list it for SGLT2 inhibitors like dapagliflozin 5

Clinical Presentation and Diagnosis

When pancreatitis is suspected in a patient taking Farxiga:

• Look for typical symptoms of acute pancreatitis:

  • Severe epigastric abdominal pain
  • Nausea and vomiting
  • Elevated lipase/amylase levels
  • Radiographic evidence of pancreatic inflammation

• Consider the temporal relationship:

  • Most reported cases occurred within weeks of initiating the medication 2, 1
  • One case reported pancreatitis occurring two weeks after starting an SGLT2 inhibitor 2

Risk Assessment and Management

If pancreatitis is suspected in a patient taking Farxiga:

1. Discontinue Farxiga immediately
2. Perform appropriate diagnostic tests (lipase, amylase, abdominal imaging)
3. Provide supportive care as needed
4. Consider alternative diabetes medications with lower pancreatitis risk

Special Considerations

• Complicating factors: In some cases, SGLT2 inhibitors have been associated with euglycemic ketoacidosis accompanying acute pancreatitis 6

• Differential diagnosis: Always rule out other common causes of pancreatitis:

  • Gallstones
  • Alcohol use
  • Hypertriglyceridemia
  • Other medications

Comparison to Other Diabetes Medications

• GLP-1 receptor agonists: Have a more established association with pancreatitis risk

  • "Pancreatitis has been reported in clinical trials, but causality has not been established" 5
  • FDA and European Medicines Agency have not identified a causal link between GLP-1RAs and pancreatitis 5

• DPP-4 inhibitors (like sitagliptin):

  • The American Diabetes Association recommends discontinuing if pancreatitis is suspected 7
  • Should not be initiated in patients with a history of pancreatitis 7

Clinical Recommendation

For patients taking Farxiga who develop symptoms suggestive of pancreatitis:

• Promptly discontinue the medication and do not rechallenge
• Evaluate for other potential causes of pancreatitis
• Consider switching to alternative diabetes medications with different mechanisms of action
• Monitor for resolution of symptoms after discontinuation

While the absolute risk appears to be low based on available evidence, clinicians should maintain vigilance for this potential adverse effect, particularly in the first few weeks after initiating therapy with Farxiga or other SGLT2 inhibitors.