Indications for FARXIGA:
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. To reduce the risk of hospitalization for heart failure (HF) in adults with type 2 diabetes mellitus and established cardiovascular disease (CVD) or multiple cardiovascular (CV) risk factors.
Limitations of Use:
Not for treating type 1 diabetes or diabetic ketoacidosis.
Initially 5mg once daily in the AM; if tolerated and need additional glycemic control; may increase to 10mg once daily. Risk reduction of hospitalization for HF: 10mg once daily. Renal impairment (eGFR <45mL/min/1.73m2): not recommended.
<18yrs: not established.
Severe renal impairment (eGFR <30mL/min/1.73m2), ESRD, or on dialysis.
Correct volume depletion before initiating. Monitor for signs/symptoms of hypotension (esp. elderly, patients with renal impairment, or on loop diuretics). Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue if suspected, evaluate and treat; consider risk factors before initiation (eg, pancreatic insulin deficiency, caloric restriction, alcohol abuse). Consider temporarily discontinuing prior to scheduled surgery (for ≥3 days) or other clinical situations (eg, prolonged fasting due to illness or post-surgery). Evaluate renal function prior to starting and monitor periodically thereafter. Risk of acute kidney injury in hypovolemia, chronic renal insufficiency, CHF, and concomitant drugs (eg, diuretics, ACEIs, ARBs, NSAIDs). Consider temporarily discontinuing in reduced oral intake or fluid losses; monitor for acute kidney injury; discontinue and treat if occurs. Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Monitor for genital mycotic infections, UTIs; treat if indicated. Severe hepatic impairment. Elderly. Pregnancy (2nd & 3rd trimesters), nursing mothers: not recommended.
Sodium-glucose co-transporter 2 (SGLT2) inhibitor.
May need a lower dose of concomitant insulin/insulin secretagogue to reduce risk of hypoglycemia. Hypotension with concomitant loop diuretics. May cause false (+) urine glucose tests or unreliable measurements of 1,5-AG assay; use alternative methods to monitor glycemic control.
Female genital mycotic infections, nasopharyngitis, UTIs (may be serious), back pain, increased urination; volume depletion, renal impairment, hypersensitivity reactions, ketoacidosis, urosepsis, pyelonephritis.
Renal; fecal (minor). Half-life: ~12.9 hours.