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Frequent nighttime urination
Urine urgency
Frequent urination
Fatigued
My mouth is dry
Peeing at night
Pee frequently
Not seeing your symptoms? No worries!
A disorder in which the body cannot properly regulate water levels. The cause is damage to either the kidneys or the pituitary gland in the brain.
Your doctor may ask these questions to check for this disease:
Treatment for this condition depends on the cause. The specialist may prescribe medications or hormones to help regulate water levels. Additionally, patients will be asked to monitor and adjust their intake of water and salts.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Farxiga in Seniors: Benefits for Heart Failure & Kidneys
A.
Farxiga can help many seniors with heart failure and chronic kidney disease by reducing hospitalizations and cardiovascular death and by slowing kidney decline, even for those without diabetes. There are several factors to consider, including side effects, when to pause it during illness or surgery, and how kidney function, blood pressure, and hydration guide safe use, so see below for important details that could shape your next steps with your clinician.
References:
* Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Chaudhry GM, et al. Age and effect of dapagliflozin in heart failure with preserved ejection fraction in DELIVER trial. Eur Heart J. 2023 Mar 1;44(9):788-798.
* Wheeler DC, Stefánsson BV, Jongs N, Chertow GM, Claggett B, Greene SJ, et al. Efficacy and safety of dapagliflozin in older versus younger patients with chronic kidney disease: a prespecified subgroup analysis of the DAPA-CKD trial. Lancet Healthy Longev. 2023 Oct;4(10):e523-e532.
* Jhund PS, Abraham WT, Butler J, Desai AS, Filippatos G, Goyal P, et al. Efficacy and Safety of Dapagliflozin in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Age: Insights From DAPA-HF. Circulation. 2022 May 31;145(22):1668-1681.
* Khazai NB, Williams K, Inman S, Kalayjian EJ, Kates M. SGLT2 inhibitors for heart failure and kidney disease: a focus on older adults. J Geriatr Cardiol. 2023 Apr 28;20(4):255-265.
* Baviera M, Manca P, De Luca M, Lapi F, Nardi R, Cammalleri V, et al. SGLT2 inhibitors in older adults: beyond glycaemic control. G Ital Cardiol (Rome). 2023 Aug;24(8):659-666.
Q.
Metoprolol for Women: Side Effects and Heart Rate Control
A.
Metoprolol helps women control heart rate and protect the heart as a beta blocker, but side effects like fatigue, dizziness when standing, cold hands, sleep or mood changes, and a slower heart rate or low blood pressure can occur. There are several factors to consider. See the complete guidance below for details on pregnancy and breastfeeding, menopause, dosing and monitoring, serious warning signs, and safe-use tips that can inform your next steps and when to contact a doctor.
References:
* Zuniga, C., et al. (2022). Sex Differences in Adverse Drug Reactions to Cardiovascular Drugs: A Systematic Review. *International Journal of Environmental Research and Public Health, 19*(2), 708.
* Franconi, F., & Campesi, I. (2015). Sex differences in the pharmacokinetics and pharmacodynamics of cardiovascular drugs. *Pharmacological Research, 98*, 33-38.
* De Vecchis, L., et al. (2021). Adverse effects of cardiovascular drugs in women: current status and challenges. *Heart Failure Reviews, 26*(6), 1145-1156.
* Kotecha, D., et al. (2021). Heart Rate Control in Atrial Fibrillation: Are There Sex Differences? *Journal of the American College of Cardiology, 77*(24), 2959-2967.
* Franconi, F., et al. (2013). Sex-related differences in the effect of cardiovascular drugs. *Pharmacological Research, 68*(1), 1-13.
Q.
Farxiga Uses: Diabetes, Heart Failure, and Kidney Disease (Explained)
A.
Farxiga treats type 2 diabetes, heart failure with reduced or preserved ejection fraction, and chronic kidney disease, including in many people without diabetes. It is an SGLT2 inhibitor that helps the kidneys excrete extra sugar and fluid, which improves blood sugar, modestly reduces weight and blood pressure, lowers heart failure hospitalizations and cardiovascular death, and slows CKD progression and the need for dialysis. There are several factors to consider, including who should avoid it and safety issues like genital or urinary infections, dehydration, and rare ketoacidosis, as well as how and when to take it; see the important details below to guide your next steps.
References:
* McCormack PL. Dapagliflozin: A Review in Type 2 Diabetes, Heart Failure and Chronic Kidney Disease. Drugs. 2022 Mar;82(4):469-484. PMID: 35147989.
* Rathi C, Jaiswal V, Gupta V, et al. Dapagliflozin: A SGLT2 Inhibitor with Pleiotropic Effects on Diabetes, Heart Failure, and Chronic Kidney Disease. Pharmaceuticals (Basel). 2022 Mar 29;15(4):418. PMID: 35402633.
* McMurray JJV, Solomon SD, Inzucchi SE, et al.; DAPA-HF Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. PMID: 31535829.
* Wiviott SD, Raz I, Bonaca MP, et al.; DECLARE-TIMI 58 Investigators. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019 Jan 24;380(4):347-357. PMID: 30427852.
* Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al.; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(15):1436-1446. PMID: 32971150.
Q.
Five important things people get wrong about farxiga
A.
Farxiga is not just a sugar pill: it protects the heart and kidneys, is used for heart failure and chronic kidney disease even without diabetes, and overall preserves kidney function despite a small early reversible GFR dip. Concerns about severe dehydration or low blood pressure are usually manageable with hydration and medication adjustments. Mild to moderate liver disease is not an automatic no, though advanced cirrhosis needs caution and close monitoring. There are several important details that may affect your next steps, so see the complete answer below.
References:
Neal B, Perkovic V, Mahaffey KW, et al. (2019). Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med, 30880345.
McMurray JJV, Solomon SD, Inzucchi SE, et al. (2019). Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med, 31517828.
D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in patients with cirrhosis: a systematic… Journal of Hepatology, 16753503.
Q.
Life past 65: What drugs should not be taken with farxiga?
A.
Key drugs to avoid or use cautiously with Farxiga after 65 include diuretics, blood pressure medicines such as ACE inhibitors, ARBs and nitrates, insulin or sulfonylureas, common NSAIDs, lithium, and potent CYP3A4 inducers or inhibitors, since combinations can raise risks of dehydration, low blood pressure, kidney problems and hypoglycemia. There are several factors to consider, including liver disease and age-related changes that may require dose adjustments, monitoring and hydration strategies; see the complete guidance below and talk with your clinician or pharmacist before changing any medication.
References:
Burness CB, & McCormack PL. (2012). Dapagliflozin: first global approval. Drugs, 22389636.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic… Journal of Hepatology, 16446105.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of decompensated… Journal of Hepatology, 30089102.
Q.
What is farxiga used for?
A.
Farxiga is an SGLT2 inhibitor used to lower blood sugar in adults with type 2 diabetes, and it also helps treat heart failure with reduced ejection fraction and slow chronic kidney disease progression, even in people without diabetes. There are several factors to consider, including common side effects like genital yeast and urinary infections, dehydration and low blood pressure, and rare ketoacidosis, plus who should avoid it such as those with type 1 diabetes or severe kidney impairment; see the complete details below to guide safe use and discuss next steps with your healthcare provider.
References:
McMurray JJV, & Solomon SD. (2019). Dapagliflozin in patients with heart failure and reduced ejecti… Lancet, 31606405.
Heerspink HJL, & Correa-Rotter R. (2020). Dapagliflozin in patients with chronic kidney disease… N Engl J Med, 32353293.
Foucher J, & de Lédinghen V. (2006). Diagnosis of cirrhosis by transient elastography: a prospect… Gastroenterology, 16530523.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Dabrowski E, Kadakia R, Zimmerman D. Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):317-28. doi: 10.1016/j.beem.2016.02.006. Epub 2016 Feb 27. PMID: 27156767.
https://www.sciencedirect.com/science/article/abs/pii/S1521690X16000117?via%3DihubDi Iorgi N, Napoli F, Allegri AE, Olivieri I, Bertelli E, Gallizia A, Rossi A, Maghnie M. Diabetes insipidus--diagnosis and management. Horm Res Paediatr. 2012;77(2):69-84. doi: 10.1159/000336333. Epub 2012 Mar 16. PMID: 22433947.
https://www.karger.com/Article/FullText/336333Robertson GL. Diabetes insipidus: Differential diagnosis and management. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):205-18. doi: 10.1016/j.beem.2016.02.007. Epub 2016 Feb 18. PMID: 27156759.
https://www.sciencedirect.com/science/article/abs/pii/S1521690X16000129?via%3DihubSchernthaner-Reiter MH, Stratakis CA, Luger A. Genetics of Diabetes Insipidus. Endocrinol Metab Clin North Am. 2017 Jun;46(2):305-334. doi: 10.1016/j.ecl.2017.01.002. Epub 2017 Feb 28. PMID: 28476225.
https://www.sciencedirect.com/science/article/abs/pii/S0889852917300026?via%3Dihub