Name of the generic: dapagliflozin
Farxiga is not considered to be a first-line treatment in the vast majority of people suffering from the type 2 form of diabetes. The initial treatment for the majority of patients suffering from Type 2 diabetes must start with diet, weight loss as well as exercise and metformin
For patients suffering from cardiorenal comorbidities, Farxiga has shown advantages for the cardio response. Yet, Farxiga is associated with just a small improvement in glycemia. However, it cost a lot and long-term safety information regarding the consequences of prolonged glucosuria aren’t available. Furthermore, there is no data on the cardiovascular effects for those with diabetes but not suffering from the obvious cardiovascular disease. All of these variables should be considered when evaluating combinations therapy in the event of a single therapy failure¶.
Farxiga can play an important role in the following situations
- In patients who have the atherosclerotic disease (CVD) not meeting the glycemic targets with metformin and lifestyle changes
- In patients suffering from heart failure that aren’t achieving their goals for glycemic control with metformin and lifestyle changes
- In patients with urine albumin-to-creatinine ratio >300 mg/g and estimated glomerular filtration rate <90 mL/min/1.73 m2
- As a third-line treatment for patients who are not meeting the glycemic targets for 2 oral medications (eg metformin and sulfonylurea) in the event that for any reason, the combination of insulin and metformin is not a viable option for treating diabetes.
- As a third-line drug in patients who are not meeting their glycemic goals for insulin therapy and metformin that have glucagon-like peptide-1 (GLP-1) receptor antagonists are ineffective and increased the dose of insulin can cause weight gain.
- As a secondary agent in patients with poor metformin-related glycemic control who are unable or unwilling to think about injection therapy, and in whom the risk of weight gain and hypoglycemia pose a major concern.
- Regardless of the initial response to therapy, the typical course of treatment for most people with Type 2 Diabetes is that blood sugar levels increase slowly over the passage of time. This is why most patients require further treatment (add an injectable or oral agent such as insulin or switch into insulin). The long-term advantages and dangers of using one treatment in comparison to another are not clear.
Precautions and contraindications
Farxiga is not recommended to treat hyperglycemia in patients suffering from:
- Type 1 diabetes
- Type 2 diabetes with estimated glomerular rate of filtration (eGFR) 60 mL/min/1.73 2 m2)
- Prior diabetic ketoacidosis (DKA)
- Farxiga provides less glycemic benefits for patients suffering from higher severity kidney diseases at the time of initiation and, to treat hyperglycemia Farxiga should not be used for patients with eGFR thresholds less than 30 mL/min/1.73 2.
- In the treatment of kidney disease, Farxiga has established renal benefits for patients who have an eGFR greater than 30 mL/min/1.73m2.
- Do not use Farxiga by patients with the following ailments due to higher risk when using these medications:
- Frequent urinary tract infections with bacterial or yeast infections of the genitourinary tract.
- Low bone mineral density and a high risk of fractures and falls.
- Foot ulceration (eg neuropathy, foot deformity, vascular disease, or an antecedent foot ulceration).
- Factors that contribute to DKA (eg type 2 diabetes prone to ketosis, pancreatic insufficiency or alcohol dependence)
Since the Farxiga can cause a mild degree of dehydration, they should be used with caution in conjunction with other medications that predispose to acute renal injury (nonsteroidal anti-inflammatory drugs [NSAIDs], angiotensin-converting enzyme [ACE] inhibitors/angiotensin II receptor blockers [ARBs], diuretics) and comorbidities that might predispose to acute renal injury
The choice of therapy
- In patients suffering from type 2 diabetes as well as kidney failure or heart disease, Farxiga has been shown to have positive effects. The choice of agent is mostly determined by the preference of the provider and insurance formulary restrictions. prescription-specific labelling for use as well as the degree of renal function and costs.
Prior to initiating Farxiga, the condition and function of the kidney (serum creatinine and eGFR) must be evaluated. The hypovolemia must be addressed prior to the initiation of the SGLT2 inhibitor. Liver function must be evaluated prior to initiating dapagliflozin or canagliflozin. People at risk of falling and fractures could benefit from an evaluation of the bone’s density.
Alongside the glycemic index (A1C and glucose levels in the blood at rest) the renal function, as well as quantity status (blood pressure), are important to monitor while receiving Farxiga treatment.
- Renal function
- Glycemic indexes
Always consult your physician to confirm that the information provided on this page is applicable to your specific situation.