Recommended Dose of Farxiga (Dapagliflozin) for Heart Failure
The recommended dose of Farxiga (dapagliflozin) for heart failure is 10 mg orally once daily, regardless of ejection fraction status. 1
Dosing Guidelines
- Dapagliflozin 10 mg once daily is the standard dose for heart failure treatment, with no need for dose titration when used specifically for heart failure 1, 2
- For patients with heart failure with reduced ejection fraction (HFrEF), the 10 mg daily dose has been shown to significantly reduce the risk of worsening heart failure and cardiovascular death 3
- The same 10 mg daily dose is effective for patients with heart failure with mildly reduced or preserved ejection fraction (HFpEF) 4
- No loading dose is required when initiating dapagliflozin for heart failure management 1
Renal Considerations
- For patients with heart failure and an eGFR ≥25 mL/min/1.73 m², the recommended dose remains 10 mg once daily 5, 1
- Initiation is not recommended in patients with an eGFR <25 mL/min/1.73 m² 1
- If eGFR falls below 25 mL/min/1.73 m² while on treatment, patients may continue the 10 mg daily dose to maintain heart failure benefits 1
- Dapagliflozin is contraindicated in patients on dialysis 5
Clinical Evidence Supporting Efficacy
- In the DAPA-HF trial, dapagliflozin 10 mg daily reduced the composite outcome of worsening heart failure or cardiovascular death by 26% compared to placebo (HR 0.74; 95% CI 0.65-0.85) 3
- Benefits were consistent regardless of diabetes status, with similar efficacy in patients with and without type 2 diabetes 6
- In the DELIVER trial, the same 10 mg daily dose reduced the risk of worsening heart failure or cardiovascular death in patients with HFpEF (HR 0.82; 95% CI 0.73-0.92) 4
- The DAPA ACT HF-TIMI 68 trial evaluated in-hospital initiation of dapagliflozin 10 mg daily, showing a trend toward benefit but not reaching statistical significance for the primary outcome 7
Administration Considerations
- Dapagliflozin can be taken at any time of day, with or without food 1
- Assess volume status before initiating therapy; correct volume depletion if present before starting dapagliflozin 1
- Assess renal function prior to initiation and periodically thereafter 1
- Temporary interruption is recommended at least 3 days prior to major surgery or procedures requiring prolonged fasting 1
Common Pitfalls and Caveats
- Do not confuse the dosing for heart failure (fixed 10 mg daily) with the dosing for type 2 diabetes, which may start at 5 mg and titrate up 1
- Volume depletion occurs in approximately 7-8% of heart failure patients taking dapagliflozin; monitor for signs of hypotension, especially in elderly patients 6
- Renal adverse events occur in 4.8-8.5% of patients; regular monitoring of kidney function is important 6
- Dapagliflozin is not indicated for type 1 diabetes due to increased risk of diabetic ketoacidosis 1
- When used for heart failure, dapagliflozin should be added to guideline-directed medical therapy rather than used as monotherapy 8