From the Guidelines
Farxiga (dapagliflozin) should not be given to patients with active gangrene, particularly Fournier's gangrene or other necrotizing fasciitis of the perineum, due to the increased risk of worsening the condition or complicating treatment. This recommendation is based on the most recent and highest quality study available, which highlights the potential risks associated with SGLT2 inhibitors, including dapagliflozin, in patients with gangrene 1. The study, published in 2025 in the journal Diabetes Care, notes that SGLT2 inhibitors can increase the risk of diabetic ketoacidosis, genital mycotic infections, and necrotizing fasciitis of the perineum, including Fournier gangrene.
Key considerations for patients with gangrene include:
- Treating the infection with appropriate antibiotics and surgical debridement if necessary
- Using alternative diabetes medications, such as insulin, metformin, DPP-4 inhibitors, or GLP-1 receptor agonists, to control blood glucose
- Avoiding the use of SGLT2 inhibitors, including Farxiga, until the gangrene has completely resolved and the patient has fully recovered
- Carefully weighing the benefits against the risk of recurrence before reconsidering Farxiga or other SGLT2 inhibitors
It is essential to prioritize the patient's safety and well-being, and to carefully consider the potential risks and benefits of using Farxiga or other SGLT2 inhibitors in patients with a history of gangrene 1. By taking a cautious approach and carefully managing the patient's condition, healthcare providers can minimize the risk of adverse outcomes and optimize treatment outcomes.
From the Research
Administration of Farxiga with Gangrene
- There have been reports of Fournier's gangrene (FG) in patients taking dapagliflozin (Farxiga), a sodium-glucose cotransporter 2 inhibitor, as noted in case reports 2, 3, 4, 5.
- These cases suggest a possible association between dapagliflozin and FG, although further evaluation and research are needed to confirm this relationship 2, 3.
- In the reported cases, patients developed FG while taking dapagliflozin, and in some instances, the medication was discontinued permanently due to the severity of the adverse event 3, 4, 5.
- The mechanism of action of dapagliflozin, which increases urinary glucose excretion, may contribute to the development of genital mycotic infections, including FG 6.
- It is essential to note that FG is a rare but life-threatening complication, and early discontinuation of dapagliflozin may be necessary in cases where FG occurs 3.
Key Considerations
- Dapagliflozin is generally well-tolerated, but it can cause adverse events such as genital mycotic infections, particularly in women 6.
- The incidence of hypoglycemia varies depending on background therapy, and dapagliflozin is not recommended in patients with moderate or severe renal impairment 6.
- Patients taking dapagliflozin should be monitored closely for signs of FG, and healthcare providers should be aware of the potential risks associated with this medication 2, 3, 4, 5.