What is the recommended dosage of Farxiga (dapagliflozin) for patients with heart failure (HF)?

Farxiga (Dapagliflozin) Dosage for Heart Failure

The recommended dosage of Farxiga (dapagliflozin) for patients with heart failure is 10 mg orally once daily, regardless of ejection fraction or diabetes status. 1

Dosing Guidelines

Standard Dosing

• Heart Failure (HF) with reduced ejection fraction (HFrEF): 10 mg orally once daily 1, 2
• Heart Failure with mildly reduced or preserved ejection fraction (HFpEF): 10 mg orally once daily 1, 3

Renal Function Considerations

• eGFR ≥25 mL/min/1.73m²: Standard dose of 10 mg once daily 1
• eGFR <25 mL/min/1.73m²:
  • Not recommended for initiation
  • If eGFR falls below 25 mL/min/1.73m² while on treatment, patients may continue the 10 mg daily dose 1

Administration Instructions

• Take at any time of day with or without food
• No dose adjustment needed based on time of day
• No loading dose required

Pre-Treatment Assessment

• Assess renal function (eGFR) before starting treatment
• Evaluate volume status - correct any volume depletion before initiating 1

Special Considerations

Temporary Interruption

• Withhold Farxiga for at least 3 days prior to major surgery or procedures requiring prolonged fasting
• Resume when patient is clinically stable and has resumed oral intake 1

Monitoring

• Regular assessment of renal function
• Monitor for signs of volume depletion, especially in elderly patients
• Watch for symptoms of diabetic ketoacidosis in patients with diabetes

Clinical Evidence

Dapagliflozin has demonstrated significant benefits in heart failure patients:

• In HFrEF patients: Reduced the composite risk of worsening heart failure or cardiovascular death by 26% compared to placebo (HR 0.74,95% CI 0.65-0.85) 2
• In HFpEF patients: Reduced the combined risk of worsening heart failure or cardiovascular death by 18% (HR 0.82,95% CI 0.73-0.92) 3
• Benefits were consistent regardless of diabetes status 4

Common Pitfalls to Avoid

1. Not assessing renal function before initiation - Always check eGFR before starting
2. Failing to correct volume depletion - Address any dehydration before starting
3. Not withholding before surgery - Remember to stop 3 days before major procedures
4. Overlooking benefits in non-diabetic patients - Dapagliflozin is effective regardless of diabetes status
5. Stopping at lower eGFR levels - Patients already on dapagliflozin can continue even if eGFR drops below 25 mL/min/1.73m² while on treatment

Dapagliflozin represents an important addition to heart failure therapy, with consistent benefits shown across the spectrum of heart failure, including both HFrEF and HFpEF, and in patients with or without diabetes.