From the Guidelines
Farxiga (dapagliflozin) may be prescribed for a patient with cor pulmonale and bacteremia without diabetes mellitus type 2 primarily for its benefits in heart failure management, as it reduces cardiovascular death and heart failure hospitalizations, regardless of diabetes status, as shown in the DAPA-HF trial 1.
Heart Failure Management
The use of SGLT2 inhibitors like Farxiga has been associated with a reduced incidence of heart failure and improved heart failure-related outcomes, including hospitalization for heart failure and heart failure-related symptoms, in people with preserved or reduced ejection fraction 1.
Mechanism of Action
In cor pulmonale, which involves right heart failure due to pulmonary hypertension, Farxiga can help reduce fluid overload, decrease cardiac workload, and improve cardiac function through its mechanism of promoting glucose and sodium excretion in urine.
Dosage and Administration
The typical dose of Farxiga is 10 mg once daily.
Precautions and Monitoring
However, caution is warranted in a patient with bacteremia, as SGLT2 inhibitors like Farxiga can increase the risk of urinary tract infections and potentially worsen infection-related outcomes.
Treatment of Bacteremia
The bacteremia should be adequately treated before starting or continuing Farxiga, and renal function should be monitored closely.
Temporary Discontinuation
The medication should be temporarily discontinued during acute illness, especially with risk of dehydration or hypotension, and resumed once the patient is stable.
Recent Evidence
Recent studies, including the DAPA-HF trial, have demonstrated the benefits of dapagliflozin in heart failure management, regardless of diabetes status 1.
Benefits of SGLT2 Inhibitors
The benefits of SGLT2 inhibitors, such as reduced incidence of heart failure and improved heart failure-related outcomes, have been consistently shown in several clinical trials, including EMPEROR-Preserved and DECLARE-TIMI 58 1.
From the FDA Drug Label
• DAPAGLIFLOZIN TABLETS are a prescription medicine used: ∘ to reduce the risk of further worsening of your kidney disease, end-stage kidney disease (ESKD), death due to cardiovascular disease, and hospitalization for heart failure in adults with chronic kidney disease ∘ to reduce the risk of cardiovascular death, hospitalization for heart failure and urgent heart failure visit in adults with heart failure, when the heart cannot pump enough blood to the rest of your body ∘ to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes who also have known cardiovascular disease or multiple cardiovascular risk factors
A patient with cor pulmonale and bacteremia may be on Farxiga (dapagliflozin) if they have heart failure or chronic kidney disease, as the medication is indicated to reduce the risk of hospitalization for heart failure and cardiovascular death in these patients, regardless of the presence of type 2 diabetes mellitus (DM2) 2.
From the Research
Patient Treatment with Farxiga (Dapagliflozin)
- A patient with cor pulmonale and bacteremia may be prescribed Farxiga (dapagliflozin) due to its benefits in reducing the risk of worsening heart failure or death from cardiovascular causes, regardless of the presence of type 2 diabetes mellitus (DM2) 3, 4.
- The DAPA-HF study reported a significant relative risk reduction with dapagliflozin in patients with New York Heart Association (NYHA) class II, III, or IV heart failure and an ejection fraction of 40%, leading to FDA approval for the treatment of heart failure with reduced ejection fraction in adults with and without type 2 diabetes 3.
- Dapagliflozin has been shown to decrease the risk of worsening heart failure or death from cardiovascular causes compared to placebo, with this risk not differing based on the presence or absence of type 2 diabetes 4.
Heart Failure and Dapagliflozin
- The DECLARE-TIMI 58 trial found that dapagliflozin reduced the composite end point of cardiovascular death/hospitalization for heart failure in patients with type 2 diabetes mellitus, with a greater benefit observed in patients with heart failure with reduced ejection fraction (HFrEF) 5.
- Dapagliflozin has been approved by the FDA for the treatment of patients with heart failure with a reduced ejection fraction with a New York Heart Association classification of II-IV, regardless of the presence of type 2 diabetes 3, 4.
Sepsis and Diabetes
- Studies have provided conflicting results regarding the impact of type 2 diabetes mellitus on sepsis-related outcomes, with some finding no difference in mortality between patients with and without type 2 diabetes 6, 7.
- However, admission hyperglycemia has been associated with increased mortality in patients with pneumonia, regardless of the presence of type 2 diabetes 7.