What patient education is necessary for a patient with a history of kidney disease taking Farxiga (dapagliflozin) to minimize adverse effects and maximize benefits?

Patient Education for Farxiga (Dapagliflozin) in Kidney Disease

Patients with kidney disease taking Farxiga must understand critical safety measures including hydration monitoring, medication timing around procedures, and recognition of serious complications like ketoacidosis and genital infections to maximize cardiovascular and renal benefits while minimizing life-threatening risks. 1

Dosing and Administration

Take Farxiga exactly as prescribed—10 mg once daily for kidney protection—and swallow tablets whole without breaking, crushing, or splitting them. 2, 1

• The standard dose for chronic kidney disease is 10 mg once daily, taken at any time of day with or without food 1
• Never split or crush tablets, as this compromises drug stability and results in unequal dosing variations of 15-25% 3
• Continue taking Farxiga even if you feel well, as kidney and heart protection occurs regardless of symptoms 4

Critical Safety Warnings

Volume Depletion and Dehydration

Monitor yourself closely for signs of dehydration—dizziness when standing, lightheadedness, or fainting—especially during the first weeks of treatment, as Farxiga increases urination and can cause dangerous volume depletion. 1, 5

• Drink adequate fluids throughout the day to prevent dehydration 1
• Be especially cautious if you are elderly, taking diuretics (water pills), or have low blood pressure 5
• Report any dizziness, lightheadedness, or fainting to your healthcare provider immediately 5

Diabetic Ketoacidosis (DKA)

Stop Farxiga immediately and seek emergency care if you experience nausea, vomiting, abdominal pain, difficulty breathing, or unusual fatigue—even if your blood sugar is normal—as these may indicate life-threatening ketoacidosis. 6, 1

• DKA can occur with normal blood glucose levels (euglycemic DKA), making it particularly dangerous 6
• Risk is highest during illness, infection, surgery, reduced food intake, or alcohol consumption 6
• Never skip meals or drastically reduce caloric intake while taking Farxiga 6

Perioperative Management

Stop taking Farxiga 3-4 days before any scheduled surgery or procedure requiring prolonged fasting to prevent ketoacidosis. 6, 1

• Inform all healthcare providers, including surgeons and anesthesiologists, that you take Farxiga 6
• Do not restart Farxiga after surgery until you are eating normally and your healthcare provider approves 6
• For emergency procedures, glucose infusion may be necessary if you remain fasting 6

Infection Recognition and Management

Genital Mycotic Infections

Watch for genital itching, burning, discharge, or odor, as Farxiga increases risk of yeast infections in both women and men—these require prompt treatment but are generally not serious. 1

• Women may experience vaginal yeast infections more frequently 1
• Men may develop yeast infections of the penis (balanitis) 1
• Contact your healthcare provider if symptoms occur; these infections are treatable 1

Serious Urinary and Perineal Infections

Seek immediate medical attention for fever with urinary symptoms, back pain, or any pain, tenderness, redness, or swelling in the genital or perineal area, as these may indicate serious infections requiring urgent treatment. 1

• Urinary tract infections (UTIs) can progress to serious kidney infections (pyelonephritis) or bloodstream infections (urosepsis) 1
• Fournier's gangrene, a rare but life-threatening infection of the genital area, has occurred in patients taking SGLT2 inhibitors like Farxiga 1
• Never delay seeking care for fever combined with genital or urinary symptoms 1

Medication Interactions and Adjustments

Hypoglycemia Risk

If you take insulin or sulfonylureas (glipizide, glyburide, glimepiride), your doses may need reduction when starting Farxiga to prevent dangerously low blood sugar. 5, 1

• Insulin doses typically require 10-20% reduction when initiating Farxiga 5
• Sulfonylurea doses may need 50% reduction or discontinuation 5
• Monitor blood glucose more frequently when starting Farxiga if you take these medications 1

Monitoring Requirements

Attend all scheduled follow-up appointments for kidney function testing, especially within the first several weeks of starting Farxiga, as kidney function must be monitored to ensure safe continuation. 5, 1

• Your healthcare provider will check your kidney function (eGFR) before starting and periodically during treatment 1
• Farxiga should not be used if your kidney function drops below certain levels (eGFR <25 mL/min/1.73 m²) 2, 1
• Report any decrease in urination or swelling in legs or feet 1

Expected Benefits in Kidney Disease

Farxiga provides substantial kidney and heart protection, reducing your risk of kidney failure by 44%, cardiovascular death or heart failure hospitalization by 29%, and overall death by 31%, regardless of whether you have diabetes. 4, 7

• These benefits occur in patients with and without type 2 diabetes 4, 8
• Protection extends across all age groups, including patients in their 70s and 80s 9
• Benefits are consistent regardless of the underlying cause of kidney disease 8
• Kidney function decline slows significantly with Farxiga treatment 4

When to Contact Your Healthcare Provider

Call your healthcare provider immediately if you experience:

• Signs of dehydration: excessive thirst, dry mouth, weakness, dizziness when standing 1
• Signs of ketoacidosis: nausea, vomiting, abdominal pain, difficulty breathing, confusion 6, 1
• Signs of serious infection: fever, chills, burning with urination, back pain 1
• Genital or perineal pain, redness, swelling, or fever 1
• Decreased urination or swelling in legs or feet 1

Lifestyle Considerations

• Maintain adequate hydration, especially during hot weather or exercise 1
• Avoid excessive alcohol consumption, which increases ketoacidosis risk 6
• Do not follow very low-carbohydrate or ketogenic diets without discussing with your healthcare provider 6
• Continue regular kidney disease management including blood pressure control and dietary modifications 2

Storage and Handling

• Store tablets at room temperature away from moisture and heat 1
• Keep medication in original container 1
• Keep out of reach of children 1