Med of the Month: Dapagliflozin (Farxiga®)

November is National Diabetes Month, making it the perfect time to spotlight a medication that's doing more than just lowering blood sugar. Meet dapagliflozin (Farxiga®), a medication that helps manage type 2 diabetes while also offering important benefits for heart and kidney health. But what does that mean for dental professionals? From managing blood pressure and recognizing dehydration to navigating drug interactions and surgical precautions, Farxiga is one medication worth getting to know before your next patient sits in the chair.

Generic Name: Dapagliflozin

Brand Name(s): Farxiga®

Pronunciation: DAP a gli FLOE zin

About dapagliflozin:

• Dapagliflozin (Farxiga®) improves blood sugar control in adults and pediatric patients aged 10 years and older with type 2 diabetes. 

• It is also used to reduce the risk of:

  • Heart-related events in adults with type 2 diabetes and known cardiovascular disease or multiple cardiovascular risk factors.

  • Worsening kidney disease, end-stage kidney disease, death due to cardiovascular disease, and hospitalization for heart failure in adults with chronic kidney disease.

Dentistry-related tidbits:

If you're treating a patient taking dapagliflozin, a few considerations are worth keeping in mind:

Local Anesthetic Warnings: 

• Monitor blood pressure when administering local anesthetics, particularly in patients at risk of hypotension or orthostasis while taking dapagliflozin.

• If administering epinephrine, remind patients with diabetes to monitor their blood sugar levels as directed, as epinephrine may temporarily increase blood glucose. In adults with significant cardiovascular risk, consider limiting epinephrine to 0.04 mg, equivalent to approximately:

  • 1 cartridge of anesthetic containing 1:50,000 epinephrine

  • 2 cartridges of anesthetic containing 1:100,000 epinephrine

  • 4 cartridges of anesthetic containing 1:200,000 epinephrine

  • Note: These are general precautions related to blood pressure and cardiovascular risk, rather than established dapagliflozin-specific local anesthetic restrictions.

Treatment Considerations:

• Dapagliflozin may cause dehydration in patients. Consider offering water if the patient appears dehydrated and is able to drink safely.

• Dapagliflozin may worsen xerostomia symptoms. Consider prescribing a fluoride supplement to use at bedtime if the patient has a high rate of caries and scheduling more frequent dental exams. 

• Always keep an emergency source of sugar in the office, such as fruit juice, honey, raisins, grapes, glucose tablets, hard candy, regular (non-diet) soda, or a glucagon pen.

• Elderly patients may be at an increased risk of developing hypotension and volume depletion. Following a procedure, allow patients to sit upright in the dental chair for a few minutes before standing to help prevent dizziness and falls.

• For patients undergoing procedures involving prolonged fasting or significant postoperative reductions in food intake, coordinate with their prescribing clinician. Dapagliflozin is generally withheld for at least 3 days before such procedures, when possible.

Staying Safe: important interactions to be aware of

Using a tool like MedAssent DDS Rx Check can help support safe prescribing and identify clinically relevant interactions.

Some of the most clinically important interactions with dapagliflozin include:

• The following medications may decrease dapagliflozin efficacy and increase risk of hyperglycemia or other glucose disturbances:

  • Steroids such as betamethasone, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisone, prednisolone, triamcinolone

  • Quinolone antibiotics such as ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin

• The following medications, when combined with dapagliflozin, may contribute to hypotension, including orthostasis or syncope, particularly in patients experiencing volume depletion:

  • Narcotics such as codeine, dihydrocodeine, hydrocodone, hydromorphone, morphine, oxycodone, oxymorphone, tramadol

  • Propofol

  • Benzodiazepines, such as midazolam and oxazepam

  • Tizanidine

Fun facts:

• This medication literally helps flush out excess sugar. Dapagliflozin belongs to a class of medications called sodium-glucose cotransporter 2 (SGLT2) inhibitors. By blocking SGLT2 proteins in the kidneys, it prevents some glucose from being reabsorbed into the bloodstream, allowing excess sugar to be eliminated through urine instead.

• Normal blood sugar doesn't always mean everything is normal. Dapagliflozin can occasionally cause euglycemic ketoacidosis, a potentially life-threatening condition in which dangerous ketone levels develop despite blood glucose levels that aren't dramatically elevated. This is especially important to recognize around surgery, prolonged fasting, or acute illness.

• Dapagliflozin is no longer just for diabetes. Farxiga® was originally approved by the FDA in 2014 to help manage type 2 diabetes. Its approved uses have since expanded to include heart failure and chronic kidney disease, even in certain patients who don't have diabetes. This serves as a good reminder to confirm each medication’s indication during health history reviews.

• In April of this year, the FDA approved the first generic version of dapagliflozin tablets.

Get more dental-specific drug information with the Digital Drug Handbook (web) or BrushUp Rx (mobile app).