Does Farxiga Cause Pancreatitis?
Farxiga (dapagliflozin) is not established as a cause of pancreatitis based on current guideline evidence, though isolated case reports exist. SGLT2 inhibitors like dapagliflozin have not been associated with increased pancreatitis risk in major clinical trials or guidelines, unlike GLP-1 receptor agonists and DPP-4 inhibitors which carry specific warnings 1.
Evidence from Guidelines
The American Diabetes Association's 2025 Standards of Care does not list pancreatitis as a safety concern for SGLT2 inhibitors, including dapagliflozin 1. This contrasts sharply with their explicit warnings for other diabetes medications:
- GLP-1 receptor agonists carry a specific caution: "Pancreatitis: acute pancreatitis has been reported, but causality has not been established. Do not initiate if at high risk for pancreatitis, and discontinue if pancreatitis is suspected" 1
- DPP-4 inhibitors similarly have documented pancreatitis concerns with recommendations to discontinue if suspected 2, 3
- SGLT2 inhibitors are notably absent from these pancreatitis warnings 1
The 2018 ACC Expert Consensus on novel diabetes therapies specifically states that the FDA and European Medicines Agency have not identified a causal link between GLP-1 receptor agonists and pancreatitis, but makes no mention of SGLT2 inhibitors having any pancreatitis association 1.
Alternative Medication Consideration
For patients at high risk for pancreatitis, SGLT2 inhibitors are actually recommended as safer alternatives to GLP-1 receptor agonists and DPP-4 inhibitors 4. The American Diabetes Association guidelines suggest considering SGLT2 inhibitors specifically because they have no associated pancreatitis risk while offering cardiovascular and renal benefits 4.
Case Report Evidence
While isolated case reports describe pancreatitis in patients taking dapagliflozin 5, 6, 7, these cases have important confounding factors:
- Hypertriglyceridemia-induced pancreatitis was the primary diagnosis in multiple cases, with dapagliflozin being coincidentally present 5, 6
- Euglycemic ketoacidosis (a known SGLT2 inhibitor complication) complicated by pancreatitis, rather than direct drug-induced pancreatitis 5, 6
- No clear temporal or dose-response relationship established in these reports 7
Clinical Implications
Continue dapagliflozin in patients without other pancreatitis risk factors. The documented benefits of SGLT2 inhibitors for cardiovascular outcomes, heart failure, and chronic kidney disease are substantial 1, and pancreatitis is not a recognized adverse effect in clinical trials or guidelines.
If pancreatitis develops in a patient on dapagliflozin, investigate other common causes first:
- Gallstones and biliary disease 1
- Hypertriglyceridemia (>1000 mg/dL) 5, 6
- Alcohol use 1
- Concomitant medications with established pancreatitis risk (GLP-1 RAs, DPP-4 inhibitors, thiopurines) 3
The primary safety concerns with dapagliflozin remain diabetic ketoacidosis (including euglycemic DKA), genital mycotic infections, and volume depletion—not pancreatitis 1.