How long does it take for Farxiga to work?
Farxiga (dapagliflozin) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is used for the treatment of type 2 diabetes, heart failure and chronic kidney disease (CKD). It starts working after just one dose, but it may take a week for Farxiga to take full effect.
In patients with type 2 diabetes, Farxiga works by stopping glucose being reabsorbed back into the body via the kidneys, which leads to more glucose being excreted when a person urinates.
After a Farxiga tablet is swallowed, it is rapidly absorbed by the body and maximum blood plasma concentrations of the drug are reached within 2 hours. Clinical trial results show that the amount of glucose removed via urine increases after just one dose. However, it takes multiple doses of once-daily Farxiga to decrease a patient's blood glucose or sugar levels, meaning that it may take a week for Farxiga to take full effect.
In patients with heart failure, Farxiga works by increasing the amount of sodium in an area of the kidneys called the distal tubule. This is linked to its mechanism of action - the way it works - in patients with diabetes. When the drug inhibits SGLT2 it stops the sodium-powered process that allows the body to reabsorb glucose. While the glucose is left to be excreted in the urine, the salt goes to work in the distal tubule to reduce the risk of cardiovascular death and hospitalization in patients with symptomatic heart failure by making it easier for the heart to work.
It is not clear exactly how Farxiga works in patients with CKD, but its effects are thought to be related to its ability to reduce intraglomerular pressure. Intraglomerular pressure is the pressure within a glomerulus - a network of small blood vessels found in the beginning of the nephron in the kidneys. The glomerulus filters the blood, enabling small molecules, waste and fluid to pass into the tubule. The tubule then returns the substances you need back to your blood and removes the waste and excess fluid as urine.
The DAPA-CKD trial investigated the benefits of Farxiga in patients with CKD. The trial compared Farxiga with placebo. Both the placebo group and the Farxiga group started with the same number of at risk patients at the beginning of the trial. By 4 months the number of patients at risk had started to reduce in both groups. This trend continued and resulted in the trial being stopped after a median of 2.4 years' follow up, by which point Farxiga was shown to improve kidney outcomes and reduce cardiovascular death.
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References
- Kasichayanula S, Liu X, Lacreta F, et at. Clinical pharmacokinetics and pharmacodynamics of dapagliflozin, a selective inhibitor of sodium-glucose co-transporter type 2. Clin Pharmacokinet. 2014 Jan;53(1):17-27. doi: 10.1007/s40262-013-0104-3.
- Food and Drug Administration (FDA). Farxiga. Highlights of Prescribing Information. [Accessed May 5, 2021]. Available online at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/202293s024lbl.pdf.
- Komoroski B, Vachharajani N, Feng Y, et al. Dapagliflozin, a novel, selective SGLT2 inhibitor, improved glycemic control over 2 weeks in patients with type 2 diabetes mellitus. Clin Pharmacol Ther. 2009 May;85(5):513-9. doi: 10.1038/clpt.2008.250. Epub 2009 Jan 7.
- NHS. Dapagliflozin. [Accessed January 28, 2021]. Available online at: https://www.nhs.uk/medicines/dapagliflozin/.
- Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa2024816.
- AstraZeneca. Farxiga approved in the US for the treatment of chronic kidney disease in patients at risk of progression with and without type-2 diabetes. April 30, 2021.[Accessed May 4, 2021]. Available from: https://www.astrazeneca.com/media-centre/press-releases/2021/farxiga-approved-in-the-us-for-ckd.html#!.
- Food and Drug Administration (FDA). FDA Approves Treatment for Chronic Kidney Disease. April 30, 2021. [Accessed May 4, 2021]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-treatment-chronic-kidney-disease.
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Drug information
- Farxiga Information for Consumers
- Farxiga prescribing info & package insert (for Health Professionals)
- Side Effects of Farxiga (detailed)
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