Restrictions:

• Indication: Restrict dapagliflozin (Farxiga) 10 mg oral tablet to heart failure indication - to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure.
• Service Line: All
• Formulary Location: Inpatient
• Service location: Inpatient
• Patient Population: Adult patient with heart failure with or without type 2 diabetes
• Prior Authorization Required: N/A

Criteria of Use (all will apply unless specified):

• Diagnosis of heart failure (regardless of ejection fraction)
• Patient is on stable diuretic dose (no increase in IV diuretic within 6 hours
• Patient does not have type 1 diabetes and/or history of ketoacidosis including diabetic ketoacidosis (DKA)
• Patient does not have symptomatic hypotension
• Avoid use 3 days before and immediately following major cardiac surgery (e.g., cardiac resynchronization therapy device implantation, mechanical assist devices, revascularization)
• Avoid use in pregnancy due to significant risks of fetal harm

• Note: For therapy initiation inpatient: prior to initiation, check patient insurance coverage to select an approved agent for after patient discharge or price checking prior to discharge

Additional notes:

• If patient has both heart failure and type 2 diabetes and is taking the formulary SGLT2 inhibitor/metformin combination product prior to admission,
  per current policy, metformin will be held upon admission, and the single agent formulary SGLT2 inhibitor will be ordered.
• If the patient only has type 2 diabetes (not heart failure), the formulary SGLT2 inhibitor will be held.

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