What is the recommended dosing for Farxiga (dapagliflozin)?

Farxiga (Dapagliflozin) Dosing Recommendations

The recommended dosage of Farxiga (dapagliflozin) is 10 mg orally once daily for most indications, with a starting dose of 5 mg daily when used for glycemic control in type 2 diabetes. 1

Dosing by Indication

For Type 2 Diabetes Glycemic Control

• Starting dose: 5 mg orally once daily 1
• May increase to 10 mg daily for additional glycemic control 1
• Not recommended for glycemic control when eGFR <45 mL/min/1.73 m² 1, 2

For Cardiovascular and Renal Indications

• Fixed dose: 10 mg orally once daily for all of the following: 1
  • Chronic kidney disease at risk of progression
  • Heart failure (with or without reduced ejection fraction)
  • Reducing hospitalization for heart failure in patients with type 2 diabetes and established cardiovascular disease or multiple risk factors 1, 2

Renal Dosing Considerations

For Glycemic Control

• eGFR ≥45 mL/min/1.73 m²: No dose adjustment required 1, 2
• eGFR <45 mL/min/1.73 m²: Not recommended for glycemic control (likely ineffective) 1, 2

For Cardiovascular/Renal Indications

• eGFR ≥25 mL/min/1.73 m²: 10 mg daily 1
• eGFR <25 mL/min/1.73 m²: Not recommended for initiation 1, 2
• If eGFR falls below 25 mL/min/1.73 m² during treatment: May continue 10 mg daily 1, 2
• Contraindicated in dialysis patients 2, 1

Special Considerations

Perioperative Management

• Withhold Farxiga for at least 3 days prior to major surgery or procedures requiring prolonged fasting 1, 2
• Resume when patient is clinically stable and has resumed oral intake 1

Adverse Effects to Monitor

• Genital mycotic infections (more common in women) 2
• Urinary tract infections 2, 3
• Volume depletion, especially in elderly or those on diuretics 2, 1
• Risk of euglycemic diabetic ketoacidosis, particularly in insulin-dependent patients 2

Practical Tips

• Assess renal function prior to initiation and periodically thereafter 1, 2
• Assess volume status before starting; correct volume depletion if present 1, 2
• No dose adjustment needed based on age, race, sex, or body weight 4
• Once-daily dosing can be taken at any time of day 5, 4
• Glucose-lowering efficacy decreases with declining renal function, but cardiovascular and renal benefits are preserved at lower eGFR levels 2

Common Pitfalls to Avoid

• Failing to distinguish between dosing for glycemic control versus cardiovascular/renal indications 1
• Initiating therapy in patients with eGFR <25 mL/min/1.73 m² 1, 2
• Not temporarily discontinuing before surgery or procedures requiring fasting 1, 2
• Overlooking the need to monitor for volume depletion in elderly patients or those on diuretics 2, 1
• Missing the risk of euglycemic ketoacidosis, which may present with minimal elevation in blood glucose 2