5 Farxiga Interactions You Should Know About

Farxiga (dapagliflozin) is an oral medication that can help treat Type 2 diabetes, heart failure, and chronic kidney disease. It belongs to a class of medications called sodium-glucose co-transporter-2 (SGLT2) inhibitors, sometimes called “flozins.” It primarily works by helping the kidneys get rid of extra blood glucose (sugar).

Because Farxiga works through the kidneys and lowers blood glucose, it can interact with other medications that affect the kidneys or blood glucose. Below, we’ll discuss five Farxiga interactions worth knowing, as they could pose a risk if you’re unaware of them.

1. Diuretics like hydrochlorothiazide

Diuretics (“water pills”), such as hydrochlorothiazide and furosemide (Lasix), are often taken to lower blood pressure or remove extra fluid from the body. People with heart failure commonly take diuretics. Farxiga is also prescribed for some types of heart failure, so some people may take both a diuretic and Farxiga. But they do interact with each other.

Diuretics and Farxiga both cause you to urinate more often as a side effect. While this could be beneficial when treating heart failure, it could also become problematic. Taking both medications can increase the risk of dehydration. This can lead to dizziness, weakness, or low blood pressure.

Talk to your healthcare provider if you start noticing dark-colored urine or a sudden decrease in urination. These are symptoms of dehydration. You may need dose adjustments for either Farxiga or your diuretic.

2. Insulin

Insulin is a widely-used medication to help treat diabetes. It helps lower blood glucose. But sometimes, it can lower glucose too much and cause hypoglycemia (blood glucose lower than 70 mg/dL). When taken by itself, Farxiga has a very low risk of causing hypoglycemia. But taking both Farxiga and insulin can make this side effect more likely.

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Hypoglycemia can cause lightheadedness, sweating, and weakness. Mild cases can typically be reversed by consuming 15 grams of a fast-acting sugar, such as a half cup of fruit juice or 4 glucose tablets. However, severe cases of hypoglycemia can be fatal if left untreated. So a quick response is important if you start to experience symptoms.

If you’ve been prescribed both Farxiga and insulin, your healthcare provider has likely already made dose adjustments to help prevent hypoglycemia. But if you notice more frequent episodes of low glucose after starting the combination, let them know. Further medication changes may be needed.

3. Sulfonylureas like glyburide

Sulfonylureas like glyburide (DiaBeta, Glynase) are a class of medications prescribed for Type 2 diabetes. They work by signaling your pancreas to release insulin. Because of this, they carry a risk of hypoglycemia. Similar to insulin, taking a sulfonylurea with Farxiga can make low blood glucose more likely.

Your healthcare provider may have you check your blood glucose more often after starting this combination. If you experience hypoglycemia, be sure to treat it quickly. And let your provider know if you notice lows more often after starting Farxiga and a sulfonylurea. They may recommend dose changes.

4. Glinides

Meglitinides (“glinides”) like repaglinide are another group of Type 2 diabetes medications. They work a lot like sulfonylureas. So they carry similar risks, including hypoglycemia. Taking Farxiga with glinides increases the risk of low blood glucose.

Your healthcare provider may make dose changes when you first start taking these medications together. Be sure to check your blood glucose at home as instructed. And let your provider know if you start having hypoglycemia episodes. They may recommend dose changes to Farxiga, your glinide, or both.

4. Lithium

Lithium (Lithobid) is a medication that can be prescribed for people living with bipolar disorder. It’s notorious for having many interactions. What’s more, minor changes in lithium dosages can greatly affect how it works in the body. Farxiga has the potential to make lithium less effective.

Lithium is removed from the body by the kidneys. So many medications that run through the kidneys, including Farxiga, interact with lithium. In this case, Farxiga can cause lithium to leave the body faster than expected. This can lower lithium levels, potentially making it less effective.

This Farxiga interaction likely wouldn’t require you to stop either medication. Your healthcare provider may recommend more frequent blood tests to check your lithium levels right after starting the combination. If they notice lower lithium levels, they’ll likely raise your dosage.

Let your healthcare provider know if you notice worsening bipolar disorder symptoms. This can point to a potential interaction.

When should I contact my healthcare provider about a Farxiga interaction?

There are a few things that you can do to help manage or prevent Farxiga interactions. Providing an updated medication list to your healthcare provider and pharmacist can help them identify possible interactions. Share this list with them when you’re first starting Farxiga and whenever any medication or supplement changes happen.

Keep an eye out for new or worse side effects after starting Farxiga. These can signify a potential interaction. Interactions don’t always lead to serious complications. But extra side effects can become bothersome and interfere with your daily routine. If anything becomes excessive, let your healthcare provider know.

If you notice more serious side effects, like symptoms of dehydration or hypoglycemia, speak with your healthcare provider. They may want to make dose adjustments. And if your blood glucose drops below 55 mg/dL, it’s best to seek medical help. This threshold is considered severe hypoglycemia and can become dangerous if not appropriately treated.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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