Can Farixa Cause Elevated Creatinine and Low GFR?
Yes, Farixa (dapagliflozin) causes a small, expected increase in serum creatinine and decrease in eGFR within the first two weeks of therapy due to hemodynamic changes, but this is typically transient and stabilizes without representing true kidney injury. 1
Expected Renal Effects Upon Initiation
Initiation of SGLT2 inhibitors like Farixa causes a small increase in serum creatinine and decrease in eGFR that generally occurs within two weeks of starting therapy and then stabilizes regardless of baseline kidney function. 1
These acute changes are due to hemodynamic alterations (reduced intraglomerular pressure from efferent arteriolar vasodilation) rather than actual kidney damage, and the effect reverses after treatment discontinuation. 1
Changes that do not fit this pattern of early onset followed by stabilization should prompt further evaluation to exclude acute kidney injury. 1
Clinical Significance and Monitoring
The initial creatinine increase represents the drug's intended mechanism of reducing glomerular hyperfiltration, similar to ACE inhibitors where a 10-20% increase in serum creatinine is anticipated and not an indication to discontinue treatment. 2
Monitor serum creatinine and eGFR before starting Farixa and within 2 weeks after initiation to capture these expected changes. 2, 1
In patients with chronic kidney disease, Farixa has demonstrated significant renoprotective benefits, reducing the composite risk of sustained eGFR decline ≥50%, end-stage kidney disease, or renal/cardiovascular death by 39% compared to placebo. 3
When to Be Concerned
Volume depletion is the primary risk factor for problematic creatinine elevation with Farixa. Patients at increased risk include: 1
- Those with impaired renal function (eGFR <60 mL/min/1.73 m²)
- Elderly patients
- Patients on loop diuretics
- Those with acute volume depletion from illness, diarrhea, or inadequate fluid intake
Before initiating Farixa in high-risk patients, assess volume status and renal function, then monitor for signs of hypotension and changes in renal function after starting therapy. 1
Distinguishing Expected from Problematic Changes
Expected pattern: Small creatinine increase within 2 weeks that stabilizes and remains stable thereafter 1
Concerning pattern: Progressive creatinine elevation beyond 2 weeks, which warrants evaluation for: 1
- Acute kidney injury from volume depletion
- Urinary tract infection/urosepsis
- Concomitant nephrotoxic medications (NSAIDs, contrast agents)
- Diabetic ketoacidosis (which can cause acute renal dysfunction)
Drug Interactions Affecting Renal Function
Avoid NSAIDs during Farixa therapy, as they increase risk of acute kidney injury and can independently cause creatinine elevation. 2, 4
Review and consider temporary discontinuation of ACE inhibitors, ARBs, or diuretics if significant volume depletion occurs, as these medications exacerbate renal dysfunction in hypovolemic states. 4
Common Pitfall to Avoid
Do not discontinue Farixa based solely on a small, early creatinine increase (within 2 weeks) that stabilizes, as this represents the drug's beneficial hemodynamic effect rather than kidney damage. 1 However, progressive increases beyond this timeframe require investigation and may necessitate drug discontinuation pending evaluation. 1