The Food and Drug Administration has approved dapagliflozin (Farxiga) to reduce the risk of hospitalization and cardiovascular death in adults with New York Heart Association class II to IV heart failure with reduced ejection fraction. Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor and was previously approved to treat type 2 diabetes and to decrease the risk of hospitalization for heart failure in patients with type 2 diabetes and known cardiovascular disease or with other risk factors for heart failure. Patients prescribed dapagliflozin for heart failure do not need to also have type 2 diabetes.

SGLT2 inhibitors prevent the reabsorption of glucose and sodium from the renal tubules. As more glucose and sodium are excreted, so is more water.

In a randomized, double-blind, placebo-controlled study conducted in 4,744 patients with New York Heart Association class II to IV heart failure and reduced ejection fraction, nearly half of whom had type 2 diabetes, dapagliflozin was found to significantly reduce the incidence of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits compared with placebo.

Potentially serious adverse effects include volume depletion and hypotension, ketoacidosis in patients with diabetes, urosepsis and pyelonephritis, hypoglycemia, necrotizing fasciitis of the perineum (Fournier's gangrene), and genital mycotic infections. The most common adverse effects are female genital mycotic infections, nasopharyngitis, and urinary tract infections. Dapagliflozin is contraindicated in those with previous hypersensitivity to the drug, those with severe renal impairment, and those on dialysis.

Nurses who work with patients prescribed dapagliflozin should provide education on its potential adverse effects. Patients should be encouraged to be well hydrated.

For complete prescribing information for dapagliflozin, go to http://www.accessdata.fda.gov/drugsatfda_docs/label/2020/202293s020lbl.pdf.