Indications and Usage of Farxiga (Dapagliflozin) in Type 2 Diabetes and Heart Failure
Farxiga (dapagliflozin) is indicated to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adults with heart failure regardless of diabetes status, as well as to reduce hospitalization risk for heart failure in adults with type 2 diabetes with established cardiovascular disease or multiple risk factors. 1
Primary Indications
Dapagliflozin has four major FDA-approved indications:
For Chronic Kidney Disease:
- Reduces risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and heart failure hospitalization in adults with chronic kidney disease at risk of progression 1
For Heart Failure:
For Type 2 Diabetes with Cardiovascular Risk:
- Reduces risk of hospitalization for heart failure in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors 1
For Glycemic Control:
- Adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus 1
Dosing and Administration
- Standard dose is 10 mg orally once daily 2
- Should be discontinued at least 3 days before planned surgery to prevent postoperative ketoacidosis 2
Heart Failure-Specific Benefits
For HFrEF:
- Significantly reduces the risk of worsening heart failure or cardiovascular death 3
- Provides 30% relative risk reduction in hospitalizations for heart failure 4
- 57% relative risk reduction in urgent heart failure visits 4
- 18% relative risk reduction in cardiovascular death 4
For HFpEF:
- First-line therapy for HFpEF (dapagliflozin 10 mg daily) regardless of diabetes status 2
- Improves symptoms and physical function 2
- Improves Kansas City Cardiomyopathy Questionnaire Clinical Summary score by 5.8 points at 12 weeks 2
- Increases 6-minute walk distance by 8.2% 2
- Reduces composite risk of worsening heart failure or cardiovascular death by 18% (HR 0.82 [95% CI 0.73–0.92]; P < 0.001) 2
Important Limitations of Use
Dapagliflozin is not recommended for:
- Improving glycemic control in patients with type 1 diabetes mellitus 1
- Improving glycemic control in adults with type 2 diabetes with eGFR less than 45 mL/min/1.73 m² 1
- Treatment of chronic kidney disease in patients with polycystic kidney disease 1
- Patients requiring or with recent history of immunosuppressive therapy for kidney disease 1
Contraindications
- History of serious hypersensitivity reaction to dapagliflozin 2
- eGFR <30 mL/min/1.73 m² for diabetes management 2
- Pregnancy or breastfeeding 2
Special Considerations and Monitoring
Medication Adjustments: When used in patients with well-controlled HbA1c or history of hypoglycemic events, consider weaning or stopping sulfonylureas or glinides 2
Renal Function: For patients with eGFR 20-30 mL/min/1.73m², Farxiga remains the only SGLT2 inhibitor option 2
Key Monitoring Needs:
- Genital mycotic infections
- Urinary tract infections
- Volume depletion/hypotension
- Risk of euglycemic diabetic ketoacidosis (particularly with insulin dose reduction, prolonged fasting, or carbohydrate restriction) 2
Additional Benefits
- May reduce the incidence of new-onset type 2 diabetes in patients with heart failure (32% reduction in diabetes incidence observed in patients with HFrEF) 5
Clinical Pearls
- Dapagliflozin works by inhibiting renal glucose reabsorption, leading to urinary glucose excretion (glucuresis) 6
- Its mechanism of action is independent of insulin secretion or action, making it complementary to other antidiabetic therapies 7
- Has a low intrinsic propensity to cause hypoglycemia when used as monotherapy 7
- Associated with weight reduction, which can be beneficial for many patients with type 2 diabetes and heart failure 7