From the Guidelines
Farxiga (dapagliflozin) should be discontinued 3 to 4 days before cataract surgery to reduce the risk of perioperative metabolic acidosis. This recommendation is based on the latest guidelines from the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines, as outlined in the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery 1. The guideline suggests that SGLT2 inhibitors, such as Farxiga, should be discontinued 3 to 4 days before surgery to minimize the risk of metabolic acidosis. Some key points to consider when holding Farxiga for cataract surgery include:
- The potential risk of dehydration and electrolyte imbalances that could complicate surgery and recovery
- The importance of monitoring blood glucose levels more frequently during the brief interruption in medication
- The need for individualized decision-making in consultation with both the ophthalmologist and the prescribing physician
- The general recommendation to resume Farxiga once normal eating and drinking have been established post-procedure, typically the day after surgery. It is essential to weigh the benefits of holding Farxiga against the potential risks of hyperglycemia and to consider alternative strategies for managing blood glucose levels during the perioperative period, as suggested by the guideline 1.
From the FDA Drug Label
• Withhold DAPAGLIFLOZIN TABLETS for at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting. (2. 4)
The medication should be withheld for at least 3 days prior to major surgery, and cataract surgery is considered a major surgery. Therefore, Farxiga (dapagliflozin) should be held for cataract surgery 2.
From the Research
Perioperative Management of Diabetic Patients Undergoing Cataract Surgery
- The management of diabetic patients undergoing cataract surgery requires careful perioperative assessment and management to reduce postoperative complications and improve surgical outcomes 3.
- Preoperative risk factors such as age, retinal diseases, hypoglycemic medications, and hemoglobin A1C (Hgb A1C) levels may play a role in patient outcomes following cataract surgery 4.
- Diabetic patients of advanced age, with a history of diabetic retinopathy who are taking insulin and have elevated Hgb A1C levels, may have an increased risk of intraoperative and postoperative complications and decreased postoperative visual acuity and visual functions 4.
Use of SGLT2 Inhibitors in Diabetic Patients Undergoing Surgery
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) such as dapagliflozin have been associated with an increased risk of euglycaemic diabetic ketoacidosis (EuDKA) in postoperative patients 5.
- To mitigate this risk, SGLT2i should be stopped 3-4 days before planned surgery with appropriate adjustments to the insulin regimen 5.
Perioperative Management of Medications
- The discontinuation of anticoagulant or antiplatelet drugs before cataract surgery may increase the risk of thromboembolism 6.
- Aspirin can be safely continued in patients undergoing cataract surgery, while warfarin has been extensively studied and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range 6.
- There is no direct evidence on the use of Farxiga (dapagliflozin) in patients undergoing cataract surgery, but based on the available evidence on SGLT2i, it is recommended to stop Farxiga 3-4 days before planned surgery with appropriate adjustments to the insulin regimen 5.