What is Farxiga (dapagliflozin) used for?

Uses of Farxiga (Dapagliflozin)

Farxiga (dapagliflozin) is primarily used to reduce the risk of cardiovascular death, hospitalization for heart failure, kidney disease progression, and to improve glycemic control in type 2 diabetes. 1

Primary Indications

Farxiga is FDA-approved for the following conditions:

• Chronic Kidney Disease (CKD)

  • Reduces the risk of further worsening of kidney disease
  • Prevents end-stage kidney disease (ESKD)
  • Reduces death due to cardiovascular disease
  • Reduces hospitalization for heart failure in adults with CKD 1

• Heart Failure

  • Reduces the risk of cardiovascular death and hospitalization for heart failure
  • Effective in heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)
  • Benefits are seen regardless of diabetes status 2, 1

• Type 2 Diabetes

  • Improves blood sugar (glucose) control in adults and children 10 years and older
  • Reduces the risk of hospitalization for heart failure in patients with type 2 diabetes who have cardiovascular disease or multiple cardiovascular risk factors 1

Mechanism of Action

Farxiga works by inhibiting sodium-glucose cotransporter-2 (SGLT2) in the kidneys, which:

• Reduces renal glucose reabsorption
• Increases urinary glucose excretion
• Lowers blood glucose levels
• Promotes mild osmotic diuresis and sodium loss 3

This mechanism is independent of insulin secretion or action, making it effective across the spectrum of type 2 diabetes progression and complementary to other antidiabetic medications 3, 4.

Clinical Benefits

Cardiovascular Benefits

• Reduces the risk of hospitalization for heart failure by 27-35% 2
• Reduces cardiovascular death (HR 0.82 [95% CI 0.69–0.98]) 2
• In the DAPA-HF trial, dapagliflozin reduced:
  • Worsening heart failure events (HR 0.70 [95% CI 0.59–0.83])
  • The composite of worsening heart failure or cardiovascular death (HR 0.74 [95% CI 0.65–0.85]) 2
• Benefits are consistent regardless of diabetes status 2

Renal Benefits

• Slows progression of kidney disease
• Reduces risk of end-stage kidney disease
• Particularly beneficial in patients with albuminuria 2, 1

Metabolic Benefits

• Reduces HbA1c by 0.5-1.0%
• Promotes weight loss of 1.5-3.5 kg
• Reduces systolic blood pressure by 3-5 mmHg 3, 4

Patient Selection Considerations

Farxiga is most appropriate for:

• Patients with type 2 diabetes with established cardiovascular disease or multiple risk factors
• Patients with heart failure (both HFrEF and HFpEF)
• Patients with chronic kidney disease
• Patients needing weight loss in addition to glycemic control 3

Important Cautions and Contraindications

Farxiga should not be used in:

• Type 1 diabetes (increased risk of diabetic ketoacidosis)
• Moderate to severe kidney problems (eGFR <45 mL/min/1.73m²) for glycemic control
• Patients with certain genetic forms of polycystic kidney disease
• Patients on immunosuppressive therapy for kidney disease 1

Common Adverse Effects

• Genital mycotic infections (more common in women)
• Urinary tract infections
• Volume depletion/dehydration (especially in elderly or those on diuretics)
• Risk of diabetic ketoacidosis (even with normal blood glucose levels) 1

Clinical Pearls

• Monitor for symptoms of ketoacidosis (nausea, vomiting, abdominal pain, fatigue, trouble breathing) even if blood glucose is <250 mg/dL
• Consider reducing diuretic doses when initiating Farxiga in patients at risk for volume depletion
• The cardiovascular and renal benefits appear to be independent of glucose-lowering effects
• Benefits for heart failure and kidney protection are seen across the spectrum of patients, with or without diabetes 2, 3

Farxiga represents an important therapeutic option with multiple benefits beyond glucose control, particularly for patients with or at risk for cardiovascular disease, heart failure, or kidney disease.