Farxiga®
Dapagliflozin
Version 2025-04 · Last reviewed April 1, 2025 · Methodology
List Price
$600+
With Insurance
$30–80 (with manufacturer coupon)
The Short Version
Evidence summary
Farxiga (Dapagliflozin) is a SGLT2 Inhibitor prescribed for Type 2 diabetes (glycemic control) and Heart failure with reduced or preserved ejection fraction. FDA-approved in January 2014.
The most commonly reported side effects are Increased urination / polyuria (10%), Genital mycotic infections (yeast) (7–8%), Urinary tract infections (7%). Expected mechanism — glucose excreted through urine. Increase water intake.
Review the funding details in the evidence section below.
What This Really Costs
Long-term cost projection based on current pricing
Monthly
$600
$55 w/ insurance
without insurance
Annual
$7.2K
$660 w/ insurance
without insurance
10 Years
$72K
$6.6K w/ insurance
without insurance
30 Years
$216K
$19.8K w/ insurance
without insurance
Lifestyle alternative: $0/month in prescriptions. Carbohydrate Restriction (<50g/day) — Low-carb diets achieve HbA1c reductions of 0.
The average American retiree spends $165,000 on healthcare over their lifetime (Fidelity, 2024). Informed choices today compound over decades.
CMS MAHA ELEVATE
This medication has lifestyle alternatives supported by evidence
See how EvidentMeds supports the CMS MAHA ELEVATE program for clinicians
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Related Evidence
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Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Metabolic & Lifestyle Alternatives
Addressing Insulin Resistance and Cardiorenal Risk: The Root Causes SGLT2 Inhibitors Bypass
Farxiga forces kidneys to excrete excess glucose — a symptomatic workaround that does not address why glucose and insulin are elevated. The root cause for most T2D patients is carbohydrate-driven hyperinsulinemia. For CKD, the underlying drivers often include poorly controlled hypertension, diabetes, and obesity. Lifestyle interventions address these root causes directly.
Important context: Evidence quality varies across these approaches. Some are well-studied with randomized controlled trial data; others are based on observational or smaller studies. These interventions are not guaranteed to replace medication for all patients. Discuss with your doctor whether any of these are appropriate for your clinical situation.
Carbohydrate Restriction (<50g/day)
Reduces the dietary glucose load that drives hyperinsulinemia — addressing the root cause rather than excreting the consequence
Low-carb diets achieve HbA1c reductions of 0.5–1.5%, often matching or exceeding SGLT2 inhibitors. Virta Health 2-year RCT: 53.5% T2D remission.
Structured Exercise (Aerobic + Resistance)
Improves insulin sensitivity through increased GLUT4 transporter expression in muscle; also directly lowers blood pressure and improves kidney function
Regular exercise improves eGFR, reduces proteinuria, and lowers blood pressure 5–10 mmHg — addressing both diabetic and CKD endpoints simultaneously.
DASH Diet for Hypertension/CKD
Specifically designed to lower blood pressure — the largest modifiable driver of CKD progression
DASH diet reduces systolic BP 8–14 mmHg; in CKD patients, blood pressure control is the single most important factor in slowing progression.
Weight Loss 7–10% Body Weight
Reduces visceral fat, improves insulin sensitivity, lowers intraglomerular pressure in kidneys
Moderate weight loss improves eGFR, reduces proteinuria, and lowers HbA1c. Bariatric surgery studies show T2D remission rates of 60–80%.
Key Studies
Global Prescribing & Pricing
Farxiga adoption is growing rapidly — AstraZeneca has successfully expanded indications beyond diabetes into cardiology and nephrology
United States
$600+/mo
Rapidly expanding — marketed aggressively for CKD and heart failure beyond diabetes
No lifestyle prerequisite; being prescribed for broader cardiorenal indications
Covered with prior authorization; manufacturer coupons common
United Kingdom
~$40–55/mo
NICE approved for T2D, heart failure, and CKD
Structured clinical guidance; lifestyle modification documented alongside
NHS covered with indication criteria
Germany
~$45–70/mo
IQWiG assessed for multiple indications
Benefit assessment required per indication; lifestyle counseling concurrent
GKV covered with criteria
Australia
~$30–50 (PBS)/mo
PBS restricted to specific criteria per indication
Specialist initiation for heart failure and CKD indications
PBS covered with criteria and authority required
Farxiga is essentially the same class as Jardiance (SGLT2 inhibitor) — the US prices both at $600+/month for drugs that cost $30–55 globally. AstraZeneca's indication expansion strategy mirrors Boehringer's with Jardiance: transform a diabetes drug into a multi-billion-dollar cardiology and nephrology franchise. The clinical benefits are real, but the pricing is not justified by production costs.
Clinical Trials & Funding
Understanding who funds research helps contextualize results. Industry-funded trials are not automatically invalid — they undergo the same FDA review — but declared conflicts and sponsor effects are worth knowing. All linked trials can be verified on ClinicalTrials.gov.
Funding Sources
All major Farxiga outcome trials were funded by AstraZeneca. The DAPA-CKD trial — which expanded the indication to chronic kidney disease regardless of diabetes status — was stopped early for "overwhelming efficacy." While the results were genuinely significant, early trial stops by sponsors tend to overestimate effect sizes. AstraZeneca has aggressively pursued indication expansion, transforming Farxiga from a diabetes drug into a cardio-renal franchise worth billions.
Declared Conflicts of Interest
AstraZeneca's marketing positions Farxiga as a "beyond-glucose" solution, emphasizing heart failure and CKD benefits. Many principal investigators on DAPA-HF and DAPA-CKD had financial relationships with AstraZeneca. The company's revenue strategy relies on maximizing non-diabetes prescriptions — where competition with cheaper generics is less intense.
Key Efficacy Results
Reduced heart failure hospitalization 27%; slowed CKD progression 39%; HbA1c reduction 0.4–0.7%; no significant reduction in major adverse CV events in DECLARE (unlike empagliflozin in EMPA-REG)
Referenced Studies
Each study carries a Cochrane RoB-2 risk-of-bias badge — tap the badge for details.
Evidence & Transparency
Cochrane RoB-2 (Risk of Bias)
Badges reflect an editorial assessment using Cochrane's RoB-2 tool domains: randomization, intervention deviation, missing data, outcome measurement, and selective reporting. These are not certified Cochrane reviews. Learn more ↗
CMS Open Payments
Manufacturer payment disclosures are reported via the CMS Sunshine Act. Disclosure is legally required and does not imply bias or misconduct. Language uses "may," "suggests," or "appears" — never definitive clinical claims. CMS Open Payments ↗
Live Clinical Trials
Live from ClinicalTrials.gov · refreshed every 4 hours
Currently enrolling, active, and recently completed studies involving Dapagliflozin. Data is pulled directly from the U.S. National Library of Medicine.
Recent Research
Live from PubMed · peer-reviewed literature · refreshed every 4 hours
Most recently indexed clinical trials and systematic reviews mentioning Dapagliflozin in PubMed.
Source Documentation
Structured citations for referenced clinical trials
Each referenced trial is listed with its registry ID, funding source, and bias assessment. Use the copy button to generate a formatted citation.
| Trial | Registry ID | Cite |
|---|---|---|
| DECLARE-TIMI 58 (CV Outcomes) | NCT01730534 | |
| DAPA-HF (Heart Failure) | NCT03036124 | |
| DAPA-CKD (Chronic Kidney Disease) | NCT03036150 |
Bias ratings use Cochrane RoB-2 methodology. Editorial assessment — not a certified Cochrane review.
Our MethodologyMedical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Common Side Effects
While taking this medication, you may experience the following common side effects. We've included tips on how to manage them.
Genital mycotic infections (yeast)
7–8%Maintain hygiene; OTC antifungals effective; more common in women
Urinary tract infections
7%Increase hydration; report fever, back pain, or bloody urine promptly
Increased urination / polyuria
10%Expected mechanism — glucose excreted through urine. Increase water intake.
Back pain
4%Usually musculoskeletal; rule out pyelonephritis if accompanied by fever
Hypotension / dizziness
4%Rise slowly; especially important if on other BP medications or diuretics
Serious Adverse Effects
- • Diabetic ketoacidosis (DKA) — can occur at NORMAL blood sugar (euglycemic DKA). Hold before surgery, fasting, or acute illness.
- • Fournier's gangrene — rare but life-threatening genital/perineal infection; seek emergency care for any genital pain, swelling, or redness
- • Acute kidney injury — especially with dehydration, NSAIDs, or diuretics
- • Lower limb amputations — class-wide concern; daily foot inspection essential
- • Severe UTIs (urosepsis) — sugar in urine creates bacterial growth medium
Drug Interactions
Major Interactions (Avoid)
Moderate Interactions (Caution)
Food Interactions
When to Contact Your Doctor
This medication requires ongoing medical supervision. The following situations warrant a prompt conversation with your prescribing physician — do not wait for your next scheduled appointment.
Contact soon if you notice
- Diabetic ketoacidosis (DKA) — can occur at NORMAL blood sugar (euglycemic DKA). Hold before surgery, fasting, or acute illness.
- Fournier's gangrene — rare but life-threatening genital/perineal infection; seek emergency care for any genital pain, swelling, or redness
- Acute kidney injury — especially with dehydration, NSAIDs, or diuretics
- Lower limb amputations — class-wide concern; daily foot inspection essential
- Blood sugar rising above target
Also discuss if you want to
- Review whether this medication is still appropriate for you
- Consider dosage adjustments based on response
- Explore lifestyle or non-drug alternatives
- Understand stopping or tapering options
- Plan monitoring labs and follow-up
In the US, call 911 or go to the nearest emergency room for severe symptoms. Poison Control: 1-800-222-1222.
Special Populations
Safety classifications for specific groups — discuss with your provider before use.
SGLT2 inhibitors cause fetal kidney development issues in second/third trimesters based on animal data. Discontinue immediately if pregnancy discovered.
Excreted in breast milk in animal studies; not recommended during breastfeeding.
Approved for T2D in children 10+ in some markets; limited pediatric data.
Higher risk of dehydration, hypotension, UTIs, and falls. Ensure adequate fluid intake. Not recommended for eGFR <20.
For glycemic control: reduced efficacy below eGFR 45. For heart failure and CKD indications: may use down to eGFR 25 (DAPA-CKD). Not recommended below eGFR 20.
FDA Adverse Event Reports
Patient-filed reports from the FDA FAERS database · refreshed daily
Community Reports
User-reported experiences — anonymous & anecdotal
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Stopping This Medication Safely
Dapagliflozin does not cause physical dependence and can generally be stopped without tapering. Blood sugar and blood pressure may rise when stopped — this is expected.
What Published Research Shows About Stopping This Medication
This summarizes what published research documents — it is not personal medical advice. Any changes to your medication require discussion with your prescribing physician.
- ·No pharmacological taper needed for dapagliflozin itself
- ·Other diabetes medications, especially insulin, may need dose adjustment before stopping
- ·Monitor blood glucose more frequently for 2–4 weeks after stopping
- ·Monitor blood pressure and fluid status — volume retention may increase
- ·For CKD patients: monitor eGFR and proteinuria after stopping
Warning Symptoms — Contact Your Doctor If You Experience:
- Blood sugar rising above target
- Signs of DKA: nausea, vomiting, abdominal pain (even with normal blood sugar)
- Increased swelling or weight gain (heart failure relapse)
- Blood pressure increase
Never change or stop a medication without consulting your prescribing physician.
Questions for Your Doctor
Questions to Ask
- 1.Am I taking this for diabetes, heart failure, or kidney disease — and does the evidence support it for my specific situation?
- 2.Is my DKA risk increased because I follow a low-carb diet or fast regularly?
- 3.Should I hold this medication before surgery or if I get sick?
- 4.Are there dietary and exercise changes that could reduce or replace this medication over time?
- 5.How will you monitor whether this is protecting my kidneys?
Lab Tests to Request
- HbA1c every 3 months initially
- eGFR, creatinine, and electrolytes
- Urine albumin-to-creatinine ratio (UACR)
- Blood pressure monitoring
- Annual foot exam
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Frequently Asked Questions About Farxiga®
- What is Farxiga® used for?
- Farxiga® (Dapagliflozin) is a SGLT2 Inhibitor manufactured by AstraZeneca. FDA-approved indications include: Type 2 diabetes (glycemic control); Heart failure with reduced or preserved ejection fraction; Chronic kidney disease (with or without diabetes); Cardiovascular risk reduction in T2D.
- What are the common side effects of Farxiga®?
- Common side effects of Farxiga® include: Genital mycotic infections (yeast) (7–8%); Urinary tract infections (7%); Increased urination / polyuria (10%); Back pain (4%); Hypotension / dizziness (4%).
- How much does Farxiga® cost?
- Farxiga® list price is approximately $600+. With insurance it typically costs $30–80 (with manufacturer coupon); without insurance approximately $550–650.
- Who funded the clinical trials for Farxiga®?
- All major Farxiga outcome trials were funded by AstraZeneca. The DAPA-CKD trial — which expanded the indication to chronic kidney disease regardless of diabetes status — was stopped early for "overwhelming efficacy." While the results were genuinely significant, early trial stops by sponsors tend to overestimate effect sizes. AstraZeneca has aggressively pursued indication expansion, transforming Farxiga from a diabetes drug into a cardio-renal franchise worth billions.
- How strong is the clinical evidence for Farxiga®?
- Key studies: DECLARE-TIMI 58 (2019), DAPA-HF (2019), DAPA-CKD (2020). Reduced heart failure hospitalization 27%; slowed CKD progression 39%; HbA1c reduction 0.4–0.7%; no significant reduction in major adverse CV events in DECLARE (unlike empagliflozin in EMPA-REG) Potential conflicts of interest: AstraZeneca's marketing positions Farxiga as a "beyond-glucose" solution, emphasizing heart failure and CKD benefits. Many principal investigators on DAPA-HF and DAPA-CKD had financial relationships w.
- Are there non-drug alternatives to Farxiga®?
- Farxiga forces kidneys to excrete excess glucose — a symptomatic workaround that does not address why glucose and insulin are elevated. The root cause for most T2D patients is carbohydrate-driven hyperinsulinemia. For CKD, the underlying drivers often include poorly controlled hypertension, diabetes See the Alternatives tab for full details.
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