Dosing of Farxiga (Dapagliflozin) in Chronic Kidney Disease
For patients with chronic kidney disease, Farxiga (dapagliflozin) should be dosed at 10 mg orally once daily if eGFR is ≥25 mL/min/1.73 m², while initiation is not recommended for patients with eGFR <25 mL/min/1.73 m². 1
Dosing Recommendations Based on Kidney Function and Indication
For CKD Indication (Renoprotection)
- eGFR ≥25 mL/min/1.73 m²: 10 mg orally once daily 2, 1
- eGFR <25 mL/min/1.73 m²: Initiation not recommended 1
- If eGFR falls below 25 mL/min/1.73 m² during treatment: May continue 10 mg once daily to maintain kidney and cardiovascular benefits 1
- Dialysis: Contraindicated 2
For Type 2 Diabetes Glycemic Control
- eGFR ≥45 mL/min/1.73 m²: Start with 5 mg once daily, may increase to 10 mg once daily for additional glycemic control 1
- eGFR <45 mL/min/1.73 m²: Not recommended for glycemic control (ineffective due to mechanism of action) 2, 1
Evidence Supporting Dosing Recommendations
The dosing recommendations are based on robust clinical evidence from landmark trials:
The DAPA-CKD trial demonstrated significant benefits with 10 mg dapagliflozin daily in patients with CKD (eGFR 25-75 mL/min/1.73 m²), showing a 39% reduction in the primary composite outcome of sustained eGFR decline, end-stage kidney disease, or death from renal or cardiovascular causes (HR 0.61,95% CI 0.51-0.72) 3
These benefits were consistent regardless of:
Monitoring and Management Considerations
Before Initiating Dapagliflozin
- Assess renal function (eGFR) 1
- Evaluate volume status and correct any volume depletion before starting 1
During Treatment
- Monitor for signs of volume depletion, especially in patients on concomitant diuretics 7
- Consider reducing diuretic doses when starting dapagliflozin to minimize risk of volume depletion 7
- Encourage adequate fluid intake (2-3 liters daily) to prevent dehydration 7
Special Situations
- Surgery: Withhold dapagliflozin for at least 3 days before major surgery or procedures with prolonged fasting 1
- Acute illness: Consider temporary discontinuation during severe illness to prevent dehydration 7
Clinical Pearls and Pitfalls
- Key Benefit: Dapagliflozin provides kidney and cardiovascular protection even when eGFR is too low for glycemic effects 2
- Common Pitfall: Failing to distinguish between dosing for glycemic control versus kidney/cardiovascular protection
- Safety Consideration: While glucose-lowering efficacy diminishes at lower eGFR levels, the kidney and cardiovascular benefits persist 7
- Patient Education: Instruct patients about signs of volume depletion and the importance of maintaining adequate hydration 7
This evidence-based approach to dapagliflozin dosing in CKD maximizes cardiorenal benefits while minimizing risks, with the 10 mg daily dose being appropriate for most CKD patients with eGFR ≥25 mL/min/1.73 m².