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

Farxiga (Dapagliflozin) Dosing for Heart Failure

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

Dosing Guidelines

• Standard dose: 10 mg orally once daily
• Renal function considerations:
  • For patients with eGFR ≥25 mL/min/1.73m², maintain the standard 10 mg daily dose
  • Not recommended to initiate therapy in patients with eGFR <25 mL/min/1.73m²
  • If eGFR falls below 25 mL/min/1.73m² while on treatment, patients may continue the 10 mg daily dose 1

Clinical Evidence Supporting This Dosing

Dapagliflozin 10 mg once daily has demonstrated significant benefits in heart failure patients across multiple landmark trials:

• DAPA-HF trial: In patients with heart failure with reduced ejection fraction (HFrEF), dapagliflozin 10 mg daily reduced the composite of worsening heart failure or cardiovascular death by 26% compared to placebo (HR 0.74,95% CI 0.65-0.85) 2

• DELIVER trial: In patients with heart failure with preserved ejection fraction (HFpEF), the same 10 mg daily dose reduced the composite of worsening heart failure or cardiovascular death by 18% (HR 0.82,95% CI 0.73-0.92) 3

Indications for Dapagliflozin in Heart Failure

Dapagliflozin 10 mg daily is indicated:

• To reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adults with heart failure (both reduced and preserved ejection fraction) 1
• For heart failure patients regardless of diabetes status 4

Special Considerations

• Temporary interruption: Withhold dapagliflozin for at least 3 days prior to major surgery or procedures associated with prolonged fasting 1
• Volume status: Assess volume status before initiating therapy and correct any volume depletion prior to starting treatment 1
• Monitoring: Assess renal function prior to initiation and periodically during treatment 1

Common Pitfalls to Avoid

1. Dosing confusion: Unlike its use in diabetes (where 5 mg may be used initially), heart failure treatment requires the full 10 mg dose from the start

2. Inadequate monitoring: Failure to assess volume status before initiation may increase risk of hypotension

3. Inappropriate discontinuation: Continuing dapagliflozin is appropriate even if eGFR falls below 25 mL/min/1.73m² while on treatment (though not recommended for initiation at this level) 1

4. Missing the benefit in non-diabetic patients: The benefits of dapagliflozin in heart failure are independent of diabetes status and apply to all heart failure patients 4, 2

Dapagliflozin represents a significant advance in heart failure management with consistent benefits across the spectrum of heart failure, regardless of ejection fraction or diabetes status, with a simple once-daily 10 mg dosing regimen.