Dapagliflozin (Farxiga) for Diabetes, Heart Failure & CKD — Weight & Metabolism
SGLT2 inhibitor with the broadest evidence base across diabetes, heart failure, and chronic kidney disease from DECLARE, DAPA-HF, DELIVER, and DAPA-CKD trials.
Overview
Dapagliflozin is an SGLT2 inhibitor with the broadest approved indication range: T2DM, HFrEF, HFpEF, and CKD. DECLARE-TIMI 58 (n=17,160) confirmed cardiovascular safety with reduced heart failure hospitalization. DAPA-HF showed 26% reduction in CV death/HF hospitalization in HFrEF. DELIVER extended this to HFpEF (18% reduction). DAPA-CKD (n=4,304) demonstrated a remarkable 39% reduction in kidney disease progression (HR 0.61), including in non-diabetic CKD - leading to early trial termination for overwhelming benefit. HbA1c reduction of 0.7-0.8% with 2-3kg weight loss. The comprehensive evidence makes dapagliflozin a cornerstone cardiorenal protective agent. PMID: 30415602, 31535829, 35920419, 32970396.
Indications
- Type 2 diabetes mellitus as monotherapy or combination therapy
- Heart failure with reduced ejection fraction (HFrEF)
- Heart failure with preserved ejection fraction (HFpEF)
- Chronic kidney disease at risk of progression (diabetic and non-diabetic, eGFR >=20)
- Cardiovascular risk reduction in T2DM
Mechanism of Action
SGLT2 upregulation increases renal glucose reabsorption threshold, contributing to hyperglycemia and sodium retention
Dosing
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Dapagliflozin (Farxiga) | 10 mg | Once daily in the morning | Single fixed dose for all approved indications; no titration required |
| Dapagliflozin (Farxiga) | 5 mg | Once daily | Lower starting dose option for patients at risk of volume depletion |
Evidence Grade
GRADE A
Safety & Contraindications
- FDA-approved since 2014; broadest cardiorenal indication range of any SGLT2 inhibitor
- Genital mycotic infections (5-10%): maintain good genital hygiene; treat promptly with antifungals
- Euglycemic DKA risk: hold before surgery, during acute illness, prolonged fasting, or ketogenic diets
- Volume depletion: caution with loop diuretics; reduce diuretic dose if adding dapagliflozin in HF patients
- Fournier's gangrene: rare necrotizing fasciitis (FDA class warning); immediate medical attention for perineal symptoms
- UTI risk slightly increased; not recommended in recurrent complicated UTIs