Medication Therapy Management for Farxiga

Patient Assessment and Monitoring

The American Diabetes Association recommends that patients with an eGFR <45 mL/min/1.73 m² should not use Farxiga for glycemic control, but it can be used for heart failure and CKD benefits down to 20-30 mL/min/1.73 m² 1
An initial "eGFR dip" of 3-5 mL/min/1.73 m² is expected after starting Farxiga and usually stabilizes, according to the American Journal of Kidney Diseases 2
Patients on dialysis should not use Farxiga, as recommended by the Endocrine Society 4
The European Heart Society recommends that patients with established cardiovascular disease or heart failure should be considered for Farxiga therapy to reduce cardiovascular death and heart failure hospitalization 5
Patients taking diuretics should have their doses adjusted when initiating Farxiga, as recommended by the Mayo Clinic Proceedings 3
The American College of Cardiology recommends that patients taking insulin or insulin secretagogues should have their doses reduced to prevent hypoglycemia when starting Farxiga 6
Patients should be educated on how to recognize and manage hypoglycemia, according to the Journal of the American College of Cardiology 6

Patients should be monitored for symptoms of volume depletion, such as dizziness and orthostatic hypotension, and educated on the importance of adequate hydration, as recommended by the Mayo Clinic Proceedings 3
Patients should be educated on good genital hygiene to prevent mycotic infections, according to the American Journal of Kidney Diseases and the Mayo Clinic Proceedings 2, 3
Patients should be aware of the symptoms of euglycemic DKA, which can occur with normal blood glucose levels, as recommended by the Mayo Clinic Proceedings 3

Patients should be educated on the "sick day" protocol for Farxiga, which includes holding the medication during acute illness with vomiting, diarrhea, or reduced food intake, as recommended by the Mayo Clinic Proceedings 3
Patients should be scheduled for regular follow-up appointments to monitor their kidney function, blood glucose, and overall health, according to the European Heart Journal and the Diabetes Care journal 1, 5
Patients should be encouraged to maintain adequate hydration and follow dietary and exercise recommendations for diabetes management, as recommended by the European Heart Journal 5
The cost of Farxiga should be considered, as it can be a barrier to SGLT2 inhibitor use, according to the Mayo Clinic Proceedings 3

Female patients who are pregnant or planning pregnancy should not use Farxiga, as recommended by the Endocrine Society
Elderly patients should be monitored for symptoms of postural hypotension, which is a higher risk in this population, according to the American Geriatrics Society
Patients with heart failure should be monitored for improvement in symptoms since starting Farxiga, as recommended by the Journal of the American College of Cardiology 6