Dapagliflozin (Farxiga)

For glycemic control, start 5 mg once daily; increase to 10 mg if needed. Glycemic use is not recommended below eGFR 45 mL/min/1.73 m2. For the labeled HF/CKD and other adult cardiorenal indications, use 10 mg daily; initiation requires eGFR >=25. Existing treatment may continue at 10 mg if eGFR subsequently falls below 25.

Correct volume depletion before treatment. Withhold for at least 3 days before surgery or prolonged fasting when possible; resume after clinical stability and oral intake return. Do not interpret continuation below 25 as permission to initiate on dialysis.

For glycemic control, use is not recommended below eGFR 45 mL/min/1.73 m2. For other adult indications, the recommended dose is 10 mg daily; do not initiate below 25. Patients already receiving it whose eGFR declines below 25 may continue 10 mg daily for the specified cardiorenal risk reduction. Renal function and volume status require assessment; correct depletion before starting. Withhold at least 3 days, if possible, before surgery or prolonged-fasting procedures; restart when clinically stable and eating. Trials did not enroll patients initially below eGFR 25 or on dialysis; trial continuation after decline or dialysis initiation is not universal permission to start in dialysis. Glycemic and cardiorenal indications must remain separate.

The June 2024 mirror separates glycemic control from other adult indications. Glycemic use is not recommended below eGFR 45 mL/min/1.73 m2. For other adult indications, use 10 mg daily; initiation is not recommended below 25, but patients whose eGFR falls below 25 while taking it may continue 10 mg daily for the stated cardiorenal outcomes. Assess renal function and correct volume depletion before initiation. The mirror advises withholding at least 3 days, if possible, before major surgery or prolonged-fasting procedures. Current official wording is separately displayed; no universal dialysis-start recommendation is inferred.

The handbook advises avoidance in its 20-60, 10-20 and <10 mL/min bands and across APD/CAPD, HD, high-flux and continuous replacement therapies. Its accompanying manufacturer note uses GFR <60. These historical glycemic-era limits differ from the subsequently expanded U.S. cardiorenal labeling.