Farxiga Appetite & Cravings Changes: What the Clinical Evidence Shows

Does Farxiga reduce appetite or change cravings?

The labeled mechanism is renal: dapagliflozin blocks sodium-glucose cotransporter 2 in the kidney so more filtered glucose is excreted in urine, which causes an osmotic diuresis [1]. Glucose lowering depends on kidney function and fades at low eGFR, while the heart and kidney benefits appear with or without diabetes [1].

What the trial data report

The label's adverse reaction table pools 12 placebo-controlled trials in adults with type 2 diabetes, each 12 to 24 weeks long: 1,393 people on placebo, 1,145 on dapagliflozin 5 mg and 1,193 on 10 mg [1]. Nausea was reported by 2.4% of the placebo group, 2.8% of the 5 mg group and 2.5% of the 10 mg group [1]. The most common reactions, at 5% or more, were female genital mycotic infections, nasopharyngitis and urinary tract infection [1].

The large outcome trials used cardiovascular and heart failure endpoints. DECLARE-TIMI 58 followed 17,160 adults with type 2 diabetes for a median of 4.2 years: cardiovascular death or hospitalization for heart failure occurred in 4.9% of those on dapagliflozin 10 mg versus 5.8% on placebo (HR 0.83, 0.73 to 0.95) [2]. In DAPA-HF, 4,744 adults with heart failure and an ejection fraction of 40% or less had worsening heart failure or cardiovascular death in 16.3% on dapagliflozin 10 mg versus 21.2% on placebo (HR 0.74, 0.65 to 0.85) over a median of 18.2 months [3].

Eating patterns the label does flag

Ketoacidosis is the label warning most closely tied to eating. Reduced caloric intake and ketogenic diet are listed among the conditions that can precipitate it, alongside acute febrile illness, surgery, volume depletion and alcohol abuse [1]. Blood glucose at presentation can be below 250 mg/dL [1]. The label lists nausea, vomiting, abdominal pain, malaise and shortness of breath as signs and symptoms, and says patients should stop Farxiga and seek medical attention immediately if they occur [1]. The label also says to withhold Farxiga, if possible, for at least 3 days before surgery or procedures involving prolonged fasting [1].

Volume depletion is the other warning tied to intake. The label lists eGFR below 60, older age and loop diuretics as raising the risk [1]. In the DECLARE loop-diuretic subgroup, volume-depletion events were 6.6% on dapagliflozin versus 6.1% on placebo [1].