Should I Stop Farxiga Before Surgery or If I’m Fasting for a Colonoscopy?

Farxiga (dapagliflozin) is an SGLT2 inhibitor commonly prescribed to help control blood sugar in adults with type 2 diabetes. Like other medications in its class, Farxiga carries a small but important risk of euglycemic diabetic ketoacidosis (euDKA), especially when you’re not eating, undergoing stress (such as surgery), or not drinking enough fluids. To use Farxiga safely, it’s critical to know whether you should stop it before certain medical procedures—and if so, for how long.

Why You Might Need to Hold Farxiga

• Risk of euDKA: Unlike typical diabetic ketoacidosis, euDKA can occur with relatively normal blood sugar levels. Fasting, surgery, or dehydration can trigger it.
• Dehydration risk: Bowel‐prep for colonoscopy often involves laxatives and limited fluid intake. Farxiga increases glucose loss in urine, which can worsen fluid and electrolyte balance.
• Stress response: Surgery triggers hormonal changes (rise in cortisol and adrenaline) that can further tip the balance toward ketone production.

Major diabetes and anesthesia societies, along with Farxiga’s own prescribing information, recommend stopping SGLT2 inhibitors ahead of planned procedures to minimize these risks.

Official Recommendations

1. Farxiga Prescribing Information (FDA-approved label)
   – Advises holding Farxiga for at least 3 days before scheduled surgery or invasive procedures.
2. American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE)
   – Recommend discontinuation 24–72 hours before procedures requiring fasting or general anesthesia.
3. Endocrine Society Guidelines
   – Stress the importance of hydration, ketone monitoring, and avoiding SGLT2 inhibitors during periods of low oral intake.

How Long Should You Stop Farxiga?

• Minimum of 3 days before major surgery requiring general anesthesia.
• At least 24–48 hours before minor procedures or colonoscopy prep that involve significant fasting or bowel cleansing.

These timeframes allow your body to clear the drug (half‐life ~13 hours) and reduce the risk of metabolic complications.

Preparing for Surgery

1. Coordinate with your care team
   – Tell your surgeon and anesthesiologist you’re taking Farxiga.
   – Work with your endocrinologist or primary care doctor to adjust other diabetes medications.

2. Stop Farxiga
   – Discontinue 3 days before the day of surgery.
   – If surgery is postponed, do not restart Farxiga until you’re eating and drinking normally.

3. Blood sugar monitoring
   – Check glucose levels more frequently.
   – Be alert for symptoms of low blood sugar (shaking, sweating, dizziness) if you’re on insulin or sulfonylureas.

4. Hydration and nutrition
   – Follow your surgical team’s fasting guidelines for solids and clear liquids.
   – If allowed, sip clear fluids up to 2 hours before anesthesia to stay hydrated.

5. Intra- and post-operative management
   – Your team may switch you to insulin or IV glucose to maintain stable blood sugar.
   – Watch for ketones if you develop nausea, vomiting or unexplained fatigue after surgery.

Preparing for a Colonoscopy

1. Discuss Farxiga with your gastroenterologist
   – Let them know you take an SGLT2 inhibitor.
   – Plan how to manage blood sugar during bowel prep.

2. Hold Farxiga
   – Stop 48 hours before starting bowel‐cleansing agents.
   – Skip the dose on the day of your procedure.

3. Manage blood sugar and ketones
   – Check glucose before and after each bowel‐prep dose.
   – If you use a blood ketone meter, test if you feel weak or nauseated.

4. Hydration strategy
   – Drink clear fluids as allowed (water, broth, specially formulated electrolyte drinks) to prevent dehydration.
   – Avoid sugar-free “diet” drinks if they contribute less than 250 mL per hour.

5. Restarting Farxiga
   – Resume only after you’re able to eat and drink normally, typically the evening after a morning procedure.
   – Confirm with your doctor that you feel well, are adequately hydrated, and have stable blood sugars.

Monitoring and Warning Signs

Even when you hold Farxiga as recommended, stay vigilant for any signs of metabolic distress or dehydration:

• Unusual nausea or vomiting
• Excessive thirst or dry mouth
• Dizziness or lightheadedness
• Rapid breathing or shortness of breath
• Fatigue or confusion
• Abdominal pain

If you experience any of these, check your blood glucose and—if possible—your ketones. Consider doing a free, online symptom check, using the doctor approved Ubie Symptom Checker.

What If I Forget to Stop Farxiga?

Mistakes happen. If you realize you took Farxiga within 24–48 hours of a planned procedure:

1. Inform your surgeon/anesthesiologist immediately.
2. Increase monitoring of blood sugars and ketones.
3. Ensure you have a plan for IV glucose or insulin if you can’t eat.
4. Watch closely for dehydration and signs of ketosis.

Your care team may choose to delay the procedure or adjust your diabetes regimen on the spot.

Resuming Farxiga Safely

• Wait until you’re eating regular meals and drinking enough fluids.
• Confirm stable blood sugars (review home glucose logs).
• Discuss any changes in diet, activity level, or concurrent medications with your doctor.
• Restart with your usual dose unless otherwise directed.

Key Takeaways

• Farxiga can increase the risk of euDKA and dehydration during fasting or stress.
• Stop Farxiga at least 3 days before major surgery; 24–48 hours before colonoscopy prep.
• Closely monitor blood sugar, ketones, and hydration status.
• Coordinate with your surgical, anesthesia, and diabetes care teams.
• Resume Farxiga only after you’re back on normal meals and fluids.
• If you develop concerning symptoms, consider using the free, online doctor-approved Ubie Symptom Checker.
• Always speak to a doctor about anything that could be life threatening or serious.

This advice is based on Farxiga’s FDA-approved labeling and current guidelines from diabetes and anesthesia experts. Every patient is unique—always double-check with your healthcare team before making any changes to your medication regimen.