#1

Farxiga comes in 10 mg and 5 mg dosing. Any thoughts on if the 5 mg dose results in similar longevity benefits as the 10 mg dose?

#2

It’s best to take the 10 mg and cut it in half to get 5 mg. Save some costs.

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#3

Thanks but do you think the 5mg provides similar longevity benefits as the 10 mg?

#4

I would say 80-90% of the benefits come in the first 5 mg.

#5

I disagree. From what I remember in RCT 5 mg was significantly less potent.

#6

Seems like 80% to me.

However, dapagliflozin monotherapy with daily doses of 5 and 10 mg produced changes in HbA1c of −13 mmol/mol (−1.19%) [−15 mmol/mol (−1.36%), −11 mmol/mol (−1.02%)] and −16 mmol/mol (−1.45%) [−17 mmol/mol (−1.59%), −14 mmol/mol (−1.31%)], respectively and changes in FPG of −42.0 mg/dl (−43.4 mg/dl, −36.8 mg/dl) and −46.5 mg/dl (−51.4 mg/dl, −41.4 mg/dl), respectively.

#7

Maybe for the changes in HbA1c (but if you’re not diabetic, your HbA1c won’t change with dapagliflozin anyway) but from what I remember for things like heart failure and all-cause mortality, the 5 mg dose was significantly less potent. I might be wrong, it’s just what comes to mind and it would take me a lot of time to dig my notes and find the sources (if they ever exist!). In any case, 5 mg of dapagliflozin is better than 0 so it’s already a great start!

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#8

Thanks for the input for all of you. Let me give you more information and I’d appreciate your input. I have been on Farxiga 10 mg for several years now. In my January 2025 labs, my BUN level was a little high at 30 mg/dl (range of 8-27). In the past it has normally been around 22 to 24 mg/dl. I lowered my sodium intake for a few weeks then we retested and it went down to 26 mg/dl. Three weeks later we tested and it was back up to 30 mg/dl–although I had maintained a lower sodium diet during those three weeks. My PCP is thinking the Farxiga may be creating a dehydrating effect so she wants me to go down to the 5 mg dose and then see what that does to BUN levels. My first thought is “I’ve been on 12 mg Farxiga for two years and no issues so why would all of a sudden it be impacting my BUN levels.” My next thought is "what’s the issue with a little bit higher BUN level?

I’d appreciate any input please. @DrFraser ?

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#9

It’s true that the flozins may cause dehydration. The answer is to drink more water.

When I started Jardiance, 12.5 mg daily, I became so thirsty, I started consuming 4-8 cups more water daily. On Jardiance, I have had to leave a movie theatre in the middle of a flick to go get a drink because the thirst was so bothersome on the verge of painful. This has never happened to me before.

So I hydrate more. I’ve also been losing weight. I don’t think either of those things are a negative BTW.

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#10

Focusing on BUN has only a small rationale. Your kidney function is what we generally worry about the most, so what is your creatinine doing, and how has that been tracking overtime.

In U.S. units, BUN/Creatinine >20 is dehydrated or “pre-renal.”

It’s only a 20% increased risk of this as compared to individuals not on these agents.

  • Evidence from Systematic Reviews: A meta-analysis published in Frontiers in Pharmacology involving 36,958 patients across 70 randomized controlled trials (RCTs) reported a significant increase in volume-related adverse events (AEs) with SGLT-2 inhibitors compared to placebo (RR 1.26, 95% CI 1.08–1.46, p < 0.05) 1 I.
  • Observational Data: A meta-analysis of 40 cohort studies including 9,911,454 patients found increased risks of volume depletion with SGLT-2 inhibitors (HR 1.20, 95% CI 1.10–1.31, p < 0.001) 2 II. While robust due to large sample sizes, these findings rely on non-randomized data and administrative coding, limiting causal inference.
  • Clinical Practice Guidelines: Recommendations from the BMJ emphasize correcting volume depletion before initiating SGLT-2 inhibitors, especially in patients with chronic kidney disease (CKD) or heart failure (strong recommendation) 3 I.
  • Specific Drug Information: According to the American Society of Health-System Pharmacists (ASHP Drug Compendium [Sotagliflozin; SGLT2 Inhibitors]), monitoring for signs of dehydration and volume contraction is critical, particularly in high-risk populations.
#11

Thank you for this info. My Creatinine has been tracking low
while BUN has been tracking high
Creatinine numbers of late (0.59, 0.67, 0.72 mg/dl). But it’s important to note that my creatinine numbers have tracked low for years
way before I started the Farxiga. Also, my egr last two labs has been 106 and 111 ml/min

#12

You can talk to your doctor - but so long as your kidney function is stable and you don’t have significant decrease in blood pressure/increase in heart rate with standing (e.g. postural vital signs abnormal) I’d ask them what they are worried about with your BUN running a bit high?

#13

Meeting with my doctor on Monday. This info is very helpful. Thank you and thank all who responded to my post.

#14

I find if I drink 2-3 litres of water in the mornings over 4-5 hours I have a normal thirst level for the rest of the day and I’m much less likely to get up to go at night. I find this effect is more obvious with empag than dapag. I take both with my first meal in the morning.

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