Farxiga (Dapagliflozin) Effects on Blood Pressure and Glucose
Yes, Farxiga (dapagliflozin) effectively lowers both blood pressure and glucose levels, with systolic blood pressure reductions of approximately 3-5 mmHg and HbA1c reductions of 0.5-1.0% in patients with type 2 diabetes. 1
Mechanism of Action
Dapagliflozin works through a unique insulin-independent mechanism:
- Inhibits sodium-glucose cotransporter-2 (SGLT2) in the renal proximal tubule
- Reduces renal glucose reabsorption, increasing urinary glucose excretion
- Promotes mild osmotic diuresis and sodium loss, contributing to BP reduction
- Provides complementary therapy when used with other antihyperglycemic medications 2
Blood Pressure Effects
Dapagliflozin has demonstrated significant blood pressure-lowering effects:
- Reduces systolic blood pressure by approximately 3-5 mmHg 1
- In dedicated hypertension studies, showed placebo-adjusted systolic BP reduction of 4.28 mmHg 3
- BP-lowering effect is particularly pronounced in patients already on β-blockers or calcium channel blockers 3
- The antihypertensive effect appears to be due to mild diuresis and sodium excretion
- BP-lowering occurs regardless of baseline blood pressure, with smaller decreases in those with lower initial BP 4
Glucose-Lowering Effects
Dapagliflozin provides consistent glycemic control:
- Reduces HbA1c by approximately 0.5-1.0% 1
- Placebo-adjusted HbA1c reduction of 0.61% demonstrated in clinical trials 3
- Provides effective glucose control both as monotherapy and in combination with other antihyperglycemic agents 2
- Low risk of hypoglycemia when used alone due to its insulin-independent mechanism 2, 5
Clinical Applications
Dapagliflozin is FDA-approved for multiple indications:
- Type 2 diabetes management (approved 2014)
- Heart failure with reduced ejection fraction (approved 2020)
- Chronic kidney disease (approved 2021)
- Heart failure with preserved ejection fraction (approved 2023) 6
The American Diabetes Association and American College of Cardiology recommend SGLT2 inhibitors like dapagliflozin for patients with:
- Type 2 diabetes with established cardiovascular disease
- Heart failure (with reduced or preserved ejection fraction)
- Chronic kidney disease
- Need for weight loss 4
Important Considerations
Potential Side Effects
- Genital mycotic infections (more common in women)
- Urinary tract infections
- Risk of volume depletion/dehydration (monitor for dizziness, lightheadedness)
- Rare risk of euglycemic diabetic ketoacidosis 7
Precautions
- Monitor for hypotension in patients on multiple antihypertensive medications
- Consider reducing diuretic doses before starting dapagliflozin in patients at risk of volume depletion 1
- Adjust doses of insulin or sulfonylureas when adding dapagliflozin to prevent hypoglycemia 1
- Use with caution in patients with renal impairment (eGFR <45 mL/min/1.73m²) 7
Dosing
- Standard dose is 10 mg once daily, with or without food
- No dose adjustment needed for mild renal impairment
- Not recommended for use in patients with severe renal impairment (eGFR <30 mL/min/1.73m²) 7
Clinical Pearls
- The blood pressure-lowering effect of dapagliflozin is additive to other antihypertensive medications
- In patients with lower baseline blood pressure, the hypotensive effect is less pronounced
- The glucose-lowering effect is independent of insulin action, making it effective across the spectrum of type 2 diabetes progression
- Benefits on blood pressure, heart failure outcomes, and renal protection appear to be class effects of SGLT2 inhibitors 4
Dapagliflozin represents an important therapeutic option that addresses multiple aspects of cardiometabolic disease through its dual effects on blood pressure and glucose control.