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

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

Farxiga (dapagliflozin) is indicated for patients with type 2 diabetes to improve glycemic control, and for patients with heart failure with reduced ejection fraction (HFrEF) to reduce the risk of cardiovascular death and hospitalization for heart failure, regardless of diabetes status. 1, 2

Indications in Type 2 Diabetes

• Approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes 3
• Reduces the risk of hospitalization for heart failure in adults with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors 3
• Provides modest reductions in blood sugar levels (approximately 0.5-0.7% reduction in HbA1c compared to placebo) 1

Indications in Heart Failure

• Indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure with reduced ejection fraction (HFrEF) 3, 1
• Benefits observed regardless of diabetes status, with a 26% reduction in the primary endpoint of worsening heart failure or cardiovascular death (HR: 0.74; 95% CI: 0.65 to 0.85) 3
• Recommended for patients with Stage C heart failure with LVEF ≤40% (HFrEF) and for patients with HFpEF (LVEF >40%), excluding those with NYHA class I symptoms 1

Dosing and Administration

• Standard dose: 10 mg orally once daily 3, 1
• Dose modifications based on renal function:
  • eGFR <45 ml/min/1.73 m²: Not recommended for glycemic control
  • eGFR <30 ml/min/1.73 m²: Contraindicated 3
  • Can be used in patients with eGFR ≥25 mL/min/1.73 m² for heart failure management 1

Contraindications

• History of serious hypersensitivity reaction to dapagliflozin
• eGFR <30 mL/min/1.73 m² (for dapagliflozin)
• Patients on dialysis
• Pregnancy or breastfeeding 3

Monitoring and Safety Considerations

• Common adverse effects to monitor:

  • Genital mycotic infections (particularly in women with prior history) 1, 2
  • Urinary tract infections 2
  • Volume depletion/hypotension 1, 2
  • Euglycemic diabetic ketoacidosis (rare but serious) 1, 2

• Important precautions:

  • Discontinue at least 3 days before planned surgery or procedures requiring prolonged fasting 3, 1
  • Monitor for hypoglycemia when used with insulin or insulin secretagogues (may require dose reduction of these agents) 2
  • Assess renal function and volume status before initiation 1
  • Monitor for signs of necrotizing fasciitis of the perineum (Fournier's gangrene) 2

Clinical Benefits

• Benefits appear early (within weeks) after initiation and are maintained in vulnerable populations 1
• Provides cardiovascular protection independent of glycemic effects 1
• Offers renal protection with slower decline in kidney function 1
• Should be continued indefinitely as part of heart failure management 1

Combination Therapy

• Can be used with other heart failure medications including diuretics, RAAS antagonists, mineralocorticoid receptor antagonists (MRAs), and evidence-based beta blockers 1
• Provides complementary therapy when used with other antihyperglycemic medications due to its insulin-independent mechanism of action 4, 5

Farxiga represents a valuable treatment option for patients with type 2 diabetes and heart failure due to its dual benefits on glycemic control and cardiovascular outcomes, with a generally favorable safety profile when used in appropriate patients.