Holding Farxiga (Dapagliflozin) Before Colonoscopy
Farxiga (dapagliflozin) should be withheld for at least 3 days (72 hours) before colonoscopy, particularly if polypectomy or other therapeutic interventions are planned. 1
FDA-Mandated Holding Period
- The FDA prescribing information for dapagliflozin explicitly states: "Withhold DAPAGLIFLOZIN TABLETS for at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting." 1
- This 3-day holding period applies to colonoscopy because the procedure requires bowel preparation with prolonged fasting and significant fluid shifts. 1
Rationale for the 3-Day Hold
- Ketoacidosis risk: SGLT2 inhibitors like dapagliflozin can precipitate euglycemic diabetic ketoacidosis during periods of fasting, dehydration, and physiologic stress—all of which occur during colonoscopy preparation. 1
- Volume depletion: The osmotic diuresis caused by dapagliflozin compounds the volume depletion from bowel preparation, increasing risks of hypotension and acute kidney injury. 1
- Mechanism-based concern: Dapagliflozin's glucose-lowering effect persists during fasting states, creating metabolic vulnerability when combined with the catabolism induced by bowel preparation. 1
Practical Implementation
- Stop dapagliflozin 3 days before the scheduled colonoscopy (e.g., if colonoscopy is Friday, last dose should be Monday). 1
- Assess volume status and renal function before initiating bowel preparation, as dapagliflozin may have already caused some degree of volume contraction. 1
- Monitor for signs of ketoacidosis (nausea, vomiting, abdominal pain, malaise) during the bowel preparation period, even if blood glucose is normal or only mildly elevated. 1
Resumption After Colonoscopy
- Restart dapagliflozin once the patient has resumed normal oral intake and adequate hydration is confirmed. 1
- Ensure hemostasis is adequate if polypectomy or biopsy was performed, though dapagliflozin itself does not affect coagulation. 1
- Verify that renal function remains stable post-procedure before restarting, particularly in elderly patients or those with baseline renal impairment. 1
Common Pitfalls to Avoid
- Do not assume a shorter hold is sufficient: The 3-day minimum is based on the drug's mechanism and metabolic risks during fasting, not simply its half-life. 1
- Do not overlook volume status assessment: Patients on dapagliflozin are at higher baseline risk for volume depletion, which bowel preparation will worsen. 1
- Do not ignore ketoacidosis warning signs: Euglycemic ketoacidosis can occur with normal or near-normal glucose levels, making it easy to miss if you only check blood glucose. 1