Farxiga and Skin Infections: Management Approach
If you develop a skin infection while taking Farxiga (dapagliflozin), continue the medication for most mild-to-moderate infections, but temporarily discontinue it for severe infections requiring hospitalization, necrotizing fasciitis, or situations involving reduced oral intake, fever, vomiting, or diarrhea. 1
Understanding the Risk
Farxiga increases the risk of certain infections through its mechanism of promoting glucose excretion in urine, which creates a favorable environment for microbial growth:
- Genital mycotic infections occur in 8.6-9.2% of patients on dapagliflozin versus 2.9% on placebo 2
- Urinary tract infections show rates of 5.0-8.5% with dapagliflozin compared to 7.9% with placebo, indicating no clear drug effect 2
- Hypersensitivity-related skin events (rash, eczema, dermatitis, urticaria) occur in 4.5% of dapagliflozin patients versus 4.3% of comparators, with serious events rare at 0.2% 3
When to Stop Farxiga Immediately
Discontinue dapagliflozin and seek urgent medical attention for the following severe skin/soft tissue infections:
- Necrotizing fasciitis of the perineum (Fournier's gangrene): pain, tenderness, erythema, or swelling in the genital or perineal area with fever or malaise requires immediate broad-spectrum antibiotics and surgical debridement 1
- Any infection requiring hospitalization with reduced oral intake 1
- Fever, vomiting, or diarrhea accompanying the infection, as these increase risk of volume depletion and diabetic ketoacidosis 1
When to Continue Farxiga
For uncomplicated skin infections, continue dapagliflozin while treating the infection:
- Simple genital mycotic infections: treat with over-the-counter antifungal medications while continuing dapagliflozin; contact your provider if symptoms persist after antifungal treatment 1
- Mild skin rashes or dermatitis: monitor and treat appropriately without stopping dapagliflozin unless symptoms worsen 1, 3
- Uncomplicated urinary tract infections not requiring hospitalization: treat with appropriate antibiotics while continuing dapagliflozin 1
Critical Monitoring During Any Infection
Even with normal blood glucose levels, watch for signs of diabetic ketoacidosis (DKA):
- Nausea, vomiting, or abdominal pain 1
- Unusual tiredness or trouble breathing 1
- Check ketones in urine or blood if these symptoms develop 1
Volume depletion risk increases during infections, particularly if you:
- Take diuretics (water pills) or blood pressure medications 1
- Are 65 years or older 1
- Have kidney problems with eGFR <60 mL/min/1.73 m² 1
When to Restart Farxiga
Resume dapagliflozin only after:
- Complete recovery from acute illness 4
- Normal oral intake is re-established 4
- No ongoing fever, vomiting, or diarrhea 4
Diabetes-Related Foot Infections: Special Considerations
If you develop a diabetic foot infection while on Farxiga:
- Continue dapagliflozin for mild-to-moderate infections while receiving appropriate antibiotic therapy 5
- Administer antibiotics for 1-2 weeks for soft tissue infections, extending to 3-4 weeks if infection is extensive or you have severe peripheral artery disease 5
- Obtain cultures before starting antibiotics to guide therapy 5
- Use systemic antibiotics shown effective in randomized trials at standard dosing 5
Common Pitfalls to Avoid
- Do not stop dapagliflozin for simple genital yeast infections—these can be managed with topical antifungals while continuing the medication 1
- Do not ignore warning signs of Fournier's gangrene (perineal pain with fever)—this requires immediate discontinuation and emergency care 1
- Do not continue dapagliflozin during any illness that prevents normal eating or drinking 1
- Maintain at least low-dose insulin if you require insulin, even when holding dapagliflozin during illness 4
Balancing Cardiovascular Benefits Against Infection Risk
The decision to continue or stop Farxiga must weigh the substantial mortality benefits against infection risks:
- Dapagliflozin reduces cardiovascular death or heart failure hospitalization by 26-29% 6, 7
- It reduces kidney disease progression by 39-44% 6, 7
- Genital infections, while more common, are typically mild and manageable 8, 9
- Serious hypersensitivity reactions are rare (0.2%) and do not require routine discontinuation 3
For most skin infections, the cardiovascular and renal protective benefits of continuing dapagliflozin outweigh the infection risks, provided the infection is not severe, necrotizing, or accompanied by systemic illness that prevents oral intake. 6, 7, 1