What is the indication and usage of Farxiga (dapagliflozin) in patients with type 2 diabetes and heart failure?

Farxiga (Dapagliflozin) Indications and Usage in Type 2 Diabetes and Heart Failure

Farxiga (dapagliflozin) is strongly recommended for patients with type 2 diabetes and heart failure across all ejection fraction ranges, with a 10 mg once daily dosing regimen for patients with eGFR ≥25 mL/min/1.73 m², as it reduces the composite risk of cardiovascular death or hospitalization for heart failure by 18%. 1

Primary Indications

Dapagliflozin has dual indications that make it particularly valuable for patients with both conditions:

1. Type 2 Diabetes Management:

   • Indicated for glycemic control in adults with type 2 diabetes
   • Recommended dose: 10 mg once daily for patients with eGFR ≥45 mL/min/1.73 m² 1
   • Works by inhibiting SGLT2 in the renal proximal tubule, increasing urinary glucose excretion and reducing blood glucose levels 2

2. Heart Failure Treatment:

   • Indicated for symptomatic heart failure across all ejection fraction ranges, regardless of diabetes status 1
   • Recommended dose: 10 mg once daily for patients with eGFR ≥25 mL/min/1.73 m² 1
   • Reduces the composite risk of cardiovascular death or hospitalization for heart failure by 18% (HR 0.82 [95% CI 0.73–0.92]; P < 0.001) 1

Dosing Considerations Based on Renal Function

• eGFR ≥45 mL/min/1.73 m²: 10 mg once daily (no dose adjustment needed) 1
• eGFR 25-45 mL/min/1.73 m²: 10 mg once daily (can be used for heart failure or CKD indications) 1
• eGFR <25 mL/min/1.73 m²: Not recommended for initiation, but may continue at 10 mg daily if already receiving treatment 1
• Patients on dialysis: Contraindicated 1

Clinical Benefits

• Cardiovascular Outcomes: Significantly reduces the risk of worsening heart failure or cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF) 3
• Glycemic Control: Consistently demonstrates reductions in HbA1c and fasting plasma glucose levels 2
• Weight Management: Associated with clinically significant reductions in body weight 1, 2
• Complementary Mechanism: Works independently of insulin secretion or action, making it an effective add-on therapy to other antidiabetic medications 2, 4

Contraindications and Precautions

• Contraindicated in:

  • Patients with history of serious hypersensitivity to dapagliflozin
  • Pregnancy and lactation
  • Patients on dialysis 1

• Common Adverse Effects to Monitor:

  • Genital mycotic infections (particularly in women)
  • Urinary tract infections
  • Volume depletion/hypotension
  • Euglycemic diabetic ketoacidosis 1

Special Considerations

• Perioperative Management: Withhold dapagliflozin for at least 3 days before major surgery or procedures requiring prolonged fasting; resume when clinically stable and oral intake has resumed 1
• Renal Function: Assess renal function and evaluate volume status before initiating therapy 1
• Hypoglycemia Risk: Low risk when used alone or with metformin, but risk increases when combined with insulin or insulin secretagogues 2, 4

Clinical Pearls

• Dapagliflozin is the only SGLT2 inhibitor option for patients with eGFR 20-30 mL/min/1.73m² 1
• The benefits of dapagliflozin in heart failure remain consistent regardless of background heart failure therapies 3
• Dapagliflozin should be continued indefinitely as part of comprehensive heart failure management 1
• For patients with albuminuria >200 mg/g and eGFR ≥20 mL/min/1.73 m², dapagliflozin provides renal protection 1