Farxiga side effects and how to avoid them

In this article:

• Common side effects
• Serious side effects
• How long do side effects last?
• Contraindications and warnings
• Interactions
• How to avoid side effects
• The bottom line

In this article

• Common side effects
• Serious side effects
• How long do side effects last?
• Contraindications and warnings
• Interactions
• How to avoid side effects
• The bottom line

Farxiga (dapagliflozin) is a prescription medication used to treat Type 2 diabetes, certain chronic kidney diseases, and congestive heart failure. It works by helping the body eliminate glucose through the urine, which can also lead to increased urination. While this mechanism can benefit heart and kidney function, it may also cause side effects. Here’s what to expect and how to manage them.

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RELATED: What is Farxiga?

Common side effects of Farxiga

The following side effects were reported in more than 2% of people taking Farxiga and at higher rates than with a placebo, according to the drug label from the manufacturer AstraZeneca.

• Genital mycotic infections (such as vaginal yeast infection)
• Nasopharyngitis (sore throat and nasal inflammation) or influenza
• Urinary tract infection
• Urinary frequency or discomfort
• Back pain
• Nausea
• Constipation
• Extremity pain
• Elevated creatinine (a blood test marker of kidney function)
• Abnormal cholesterol

Urinary tract infection

About 5% of individuals experience a urinary tract infection (UTI) while taking Farxiga. A 2021 review found that Farxiga was the only SGLT2 inhibitor associated with a statistically significant increase in UTI risk. A burning feeling with urination and increased frequency of urination are common UTI symptoms. However, more severe UTIs can occur and are typically heralded by fever, back pain, or vomiting. Whether mild or severe, UTI symptoms necessitate immediate medical attention.

RELATED: Home remedies for UTI prevention and treatment

Yeast infections

Genital yeast infections afflict about 8% of women and 3% of men on Farxiga, likely as a result of glucosuria (sugar in the urine). Vaginal yeast infections in women and yeast balanitis (foreskin infection) in men occur. Soreness, itchiness, or white, cottage cheese-like discharge can be the telltale signs and should lead to seeking medical care. 

If redness of skin, swelling, pain, or fever are experienced, these can be warning signs of a different problem, a dangerous bacterial infection called Fournier’s gangrene, a form of necrotizing fasciitis that has been reported with SGLT2 inhibitors like Farxiga. Fournier gangrene is a severe infection of the skin and soft tissue of the genitals and perineum, which can involve the penis or scrotum of men and labia of women. Emergent medical treatment is needed in these circumstances.

RELATED: Home remedies for yeast infections

Serious side effects of Farxiga

• Hypersensitivity, allergic reactions, or anaphylaxis (severe allergic reaction that can be life-threatening)
• Acute kidney injury or renal impairment (reduced kidney function)
• Diabetic ketoacidosis (DKA)
• Serious UTI
• Orthostatic hypotension (drop in blood pressure upon sitting or standing up)
• Fournier gangrene

Kidney injury

Early case reports of sudden kidney injury with SGLT2 inhibitors raised concern that the drug category could cause a decrease in kidney function. However, subsequent investigation has seemed to dispel that concern somewhat. Because Farxiga can cause one to urinate more and excessive urination can lead to dehydration, which is detrimental to kidney function, the monitoring of hydration status and kidney function is worthwhile during therapy. Long-term kidney health benefits from SGLT2 inhibitors like Farxiga as long as dehydration is avoided.

Orthostatic hypotension

Low blood pressure precipitated by sitting up or standing up is termed orthostatic hypotension. A momentary lightheaded or dizzy feeling could occur in mild cases, but fainting could happen in more severe degrees of orthostatic hypotension. Fainting brings with it a risk for injuries such as bone fractures. The root cause of orthostatic hypotension with SGLT2 inhibitors is likely increased urination, which causes loss of body water and leads to a degree of dehydration. Accordingly, the prescribing healthcare provider may advise drinking plenty of fluids before starting and during therapy with Farxiga.

How long do Farxiga side effects last?

Certain Farxiga adverse effects may resolve with discontinuation. Urinary frequency, nausea, and constipation are examples of this category. Other possible side effects, like infections and serious allergic reactions, require medical treatment to resolve. A healthcare provider or pharmacist can provide medical advice specific to your condition and symptoms.

Farxiga contraindications and warnings

Farxiga is not habit-forming, and it does not cause withdrawal symptoms if stopped. However, there are some restrictions:

• Overdose: The maximum recommended dose is 10 mg daily. Call Poison Control at 1-800-222-1222 and seek emergency help if overdose is suspected.
• Pregnancy/Breastfeeding: Avoid Farxiga in the second or third trimester. There is limited data on safety during breastfeeding.
• Children: Not approved for those under 18.
• Kidney function: Often avoided in those with very severe chronic kidney disease.
• Other conditions: Avoid if you have Type 1 diabetes, DKA, are on dialysis, are dehydrated, or have had an allergic reaction to Farxiga or similar medications.

Farxiga interactions

Many of Farxiga’s drug interactions are related to additive effects on kidney function or dehydration. A healthcare professional should review the patient’s full list of medications, including prescription drugs, over-the-counter agents, and supplements.

• Medications that can cause kidney damage or renal function impairment, such as aminoglycoside antibiotics like gentamicin or nonsteroidal anti-inflammatory drugs like ibuprofen, are used cautiously or avoided in combination with Farxiga.
• Diuretics, including furosemide, are another drug class to be cautious about if used along with SGLT2 drugs, because both classes increase urine production and lead to dehydration. However, Farxiga and diuretics are often prescribed together for congestive heart failure.
• Hypoglycemic medicines, namely insulins and sulfonylurea drugs, can cause dangerously low blood sugar, and this happens more often when given concomitantly with SGLT2 drugs. 
• Anything that causes the body to make more ketones, a process called ketosis, should also be avoided with Farxiga due to the fear of DKA. Type 1 diabetes mellitus and pancreatic insulin insufficiency are classic examples of conditions that do so, but alcohol abuse is another potential risk factor. Signs of DKA include nausea, vomiting, abdominal pain, trouble breathing, and tiredness.

How to avoid Farxiga side effects

1. Stay hydrated: Unless instructed by a healthcare provider to limit fluid intake, drink plenty of fluids to help maintain blood pressure and kidney function.
2. Avoid fasting or extreme calorie restriction: These may raise your risk of DKA.
3. Tell your healthcare provider about a history of UTIs, yeast infections, or kidney problems.
4. Ask about regular monitoring of blood sugar levels and kidney function.
5. Report side effects early: Call your provider if you feel dizzy, lightheaded, or notice urinary or genital issues.

The bottom line

Farxiga side effects are usually manageable, especially with proactive care. Staying hydrated, monitoring for signs of infection, and talking to your provider regularly can help you stay on track with your treatment.

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