Farxiga, whose active ingredient is dapagliflozin, is a prescription medication used to manage blood sugar in adults with type 2 diabetes, treat heart failure, and slow the progression of chronic kidney disease. As a sodium-glucose cotransporter-2 (SGLT2) inhibitor, it works by causing the kidneys to remove excess glucose from the body through urine. Due to this mechanism, Farxiga can interact with various other drugs and substances, necessitating careful consideration and medical supervision.
Medications and substances posing a risk with Farxiga
Increased risk of hypoglycemia (low blood sugar)
Combining Farxiga with other medications that also lower blood sugar can lead to hypoglycemia, a condition where blood sugar levels drop dangerously low. Symptoms can include dizziness, headache, sweating, and confusion. This is a particularly important concern for patients with diabetes who are already on a strict blood sugar management plan.
- Insulin: When Farxiga is added to an insulin regimen, the risk of hypoglycemia increases significantly. A doctor may need to lower the insulin dosage and increase blood sugar monitoring to manage this interaction.
- Sulfonylureas: These oral diabetes medications, including glimepiride (Amaryl), glipizide (Glucotrol), and glyburide, signal the pancreas to release more insulin. The combined effect with Farxiga substantially raises the risk of low blood sugar, often requiring a dose adjustment by a healthcare provider.
- Meglitinides (Glinides): Similar to sulfonylureas, glinides like repaglinide also stimulate insulin release. Taking them with Farxiga increases the risk of hypoglycemia, and your doctor may adjust dosages accordingly.
- Chromium and Garlic Supplements: Some herbal supplements are known to affect blood sugar levels. For example, chromium and garlic supplements may have a blood sugar-lowering effect, and when taken with Farxiga, could lead to hypoglycemia. It is important to discuss any supplements with your doctor or pharmacist.
Increased risk of dehydration and low blood pressure
Farxiga's action of increasing glucose excretion through urine also leads to increased fluid loss. Combining it with other medications that have a diuretic effect can exacerbate this, leading to dehydration and hypotension (low blood pressure).
- Diuretics (Water Pills): Taking Farxiga with diuretics, such as loop diuretics like furosemide (Lasix) or thiazide diuretics like hydrochlorothiazide, increases the risk of volume depletion. This can result in dizziness, fainting, and potentially kidney problems. Patients on these medications may need increased monitoring and hydration advice from their doctor.
- ACE Inhibitors and ARBs: Certain blood pressure medications, including angiotensin-converting enzyme (ACE) inhibitors (e.g., ramipril, captopril) and angiotensin II receptor blockers (ARBs) (e.g., losartan, valsartan), can increase the risk of low blood pressure and hypoglycemia when combined with Farxiga. Regular blood pressure and blood sugar monitoring may be necessary.
Other significant drug and substance interactions
- Lithium (Lithobid): Farxiga can interfere with the way the kidneys excrete lithium, a mood-stabilizing medication. This can cause lithium levels in the body to drop, reducing its effectiveness. Close monitoring of lithium levels is crucial when initiating or changing Farxiga dosage.
- Alcohol: Heavy or chronic alcohol use with Farxiga should be avoided as it increases the risk of dehydration, hypoglycemia, and a rare but serious condition called ketoacidosis. Alcohol can also mask the symptoms of low blood sugar, making it harder to recognize and treat.
- Corticosteroids: Medications like prednisone can cause blood sugar levels to rise, which can counteract the glucose-lowering effect of Farxiga. This can make Farxiga less effective in managing blood sugar.
Farxiga drug interaction comparison table
| Interacting Medication Class | Examples | Primary Interaction Effect | Potential Outcome | Management Strategy |
|---|---|---|---|---|
| Other Diabetes Medications | Insulin, Sulfonylureas (glipizide), Glinides (repaglinide) | Additive blood sugar reduction | Hypoglycemia (low blood sugar) | Dose reduction of other medications, increased glucose monitoring |
| Diuretics | Furosemide (Lasix), Hydrochlorothiazide | Increased urination and fluid loss | Dehydration, Low Blood Pressure | Increased hydration, close monitoring of fluid status and blood pressure |
| Lithium | Lithium (Lithobid) | Increased kidney excretion of lithium | Reduced lithium effectiveness | Frequent monitoring of lithium blood levels |
| ACE Inhibitors and ARBs | Ramipril (Altace), Losartan (Cozaar) | Increased risk of low blood pressure | Symptomatic hypotension | Close monitoring of blood pressure and glucose levels |
Important considerations and management
Patients should always inform their healthcare provider of all medications and supplements they are taking before starting or while on Farxiga. The healthcare team can assess for potential interactions and create a safe treatment plan. In some cases, a healthcare provider may decide to prescribe both Farxiga and an interacting medication, but with closer monitoring and dose adjustments to mitigate risks.
It is sometimes necessary to temporarily stop Farxiga treatment, such as before scheduled surgery or during an acute illness involving vomiting or diarrhea, to reduce the risk of dehydration and ketoacidosis. Always consult with your doctor for specific instructions regarding treatment interruptions.
For additional information, the National Institutes of Health offers resources on clinical research related to dapagliflozin and its effects.
Conclusion
Navigating the complex landscape of medication interactions is a critical part of safe patient care. By understanding what medication should not be taken with Farxiga, both patients and healthcare providers can proactively manage potential risks. Key interactions involve other diabetes medications, diuretics, lithium, and alcohol, each requiring a specific management approach to prevent hypoglycemia, dehydration, or reduced treatment efficacy. Open communication with a healthcare team is essential to ensure a safe and successful treatment outcome while taking Farxiga.
