Alternatives to Dapagliflozin If You Can't Fill Your Prescription

What to Do When You Can't Fill Your Dapagliflozin Prescription

If you've been prescribed Dapagliflozin (brand name Farxiga) and your pharmacy can't fill it, you may be wondering what your options are. Whether it's a stock issue, an insurance denial, or a cost problem, there are real alternatives worth discussing with your doctor.

This guide covers what Dapagliflozin is, how it works, and the most common alternatives that your healthcare provider may consider.

Important: Never switch medications on your own. Always talk to your doctor before making any changes to your treatment plan.

What Is Dapagliflozin?

Dapagliflozin is a prescription medication in the SGLT2 inhibitor drug class. It was first approved by the FDA in 2014 and is manufactured by AstraZeneca under the brand name Farxiga.

It's currently approved to treat:

• Type 2 diabetes (as an add-on to diet and exercise)
• Heart failure (to reduce the risk of hospitalization and cardiovascular death)
• Chronic kidney disease (to slow disease progression)

For a deep dive into what this medication does, see our article on what Dapagliflozin is and how it's used.

How Does Dapagliflozin Work?

Dapagliflozin works by blocking a protein in your kidneys called SGLT2 (sodium-glucose cotransporter 2). Normally, this protein reabsorbs glucose from your urine back into your bloodstream. By blocking it, Dapagliflozin causes your body to excrete more glucose through urine, which lowers your blood sugar.

Beyond blood sugar control, SGLT2 inhibitors also reduce sodium reabsorption, which lowers blood pressure, decreases fluid overload on the heart, and has protective effects on the kidneys. This is why Dapagliflozin has become so important for treating heart failure and CKD — not just diabetes.

Learn more in our detailed explanation of how Dapagliflozin works.

Alternatives to Dapagliflozin

If you can't get Dapagliflozin, your doctor will likely look at other medications in the same SGLT2 inhibitor class first, since they work through the same mechanism. Here are the most common alternatives:

1. Empagliflozin (Jardiance)

Empagliflozin is probably the closest alternative to Dapagliflozin. Like Dapagliflozin, it's an SGLT2 inhibitor approved for type 2 diabetes, heart failure, and chronic kidney disease. It's made by Eli Lilly and Boehringer Ingelheim.

• Dosage: 10 mg or 25 mg once daily
• Approved for: Type 2 diabetes, heart failure (HFrEF and HFpEF), and CKD
• Key difference: Jardiance has similar clinical evidence and is often covered by insurance plans that don't cover Farxiga, and vice versa
• Cost: Similar price range to Farxiga; generic Empagliflozin may also be available

2. Canagliflozin (Invokana)

Canagliflozin was the first SGLT2 inhibitor approved in the U.S. (2013). It's effective for type 2 diabetes and has also shown kidney-protective benefits in patients with diabetic nephropathy.

• Dosage: 100 mg or 300 mg once daily
• Approved for: Type 2 diabetes, reducing the risk of major cardiovascular events and diabetic nephropathy progression
• Key difference: Canagliflozin carries a boxed warning about an increased risk of lower limb amputations, particularly in patients with peripheral vascular disease. This risk has not been observed with Dapagliflozin or Empagliflozin.
• Cost: Brand-name pricing is similar; generic availability varies

3. Ertugliflozin (Steglatro)

Ertugliflozin is another SGLT2 inhibitor, made by Merck. It's approved for type 2 diabetes but does not currently have FDA approval for heart failure or CKD.

• Dosage: 5 mg or 15 mg once daily
• Approved for: Type 2 diabetes only
• Key difference: More limited indications than Dapagliflozin. Not the best substitute if you take Dapagliflozin specifically for heart failure or CKD.
• Cost: May be less expensive depending on insurance coverage

4. Bexagliflozin (Brenzavvy)

Bexagliflozin is the newest SGLT2 inhibitor on the market, approved in 2023 for type 2 diabetes. It's a less well-known option but works through the same mechanism.

• Dosage: 20 mg once daily
• Approved for: Type 2 diabetes only
• Key difference: Limited clinical trial data for heart failure and CKD compared to Dapagliflozin and Empagliflozin

What If SGLT2 Inhibitors Aren't Available?

If no SGLT2 inhibitor is available or appropriate for you, your doctor may consider other drug classes depending on your condition:

• For type 2 diabetes: GLP-1 receptor agonists (like Semaglutide or Liraglutide), DPP-4 inhibitors (like Sitagliptin), or Metformin
• For heart failure: ACE inhibitors, ARBs, beta-blockers, or ARNI medications (like Sacubitril/Valsartan)
• For CKD: ACE inhibitors or ARBs to slow kidney disease progression

Your healthcare provider will choose the best option based on your specific diagnoses, other medications, and health history.

Before You Switch: Steps to Try First

Before moving to an alternative medication, consider these steps:

1. Check availability with Medfinder: Use Medfinder to see if another pharmacy near you has Dapagliflozin in stock. The issue may be pharmacy-specific, not a true shortage.
2. Ask about brand vs. generic: If your pharmacy is out of Farxiga, generic Dapagliflozin may be available — and vice versa.
3. Appeal insurance denials: If your insurance won't cover Dapagliflozin, your doctor can submit a prior authorization or appeal. Sometimes a letter of medical necessity is all it takes.
4. Look into savings programs: AstraZeneca offers a savings card that can bring the cost as low as $0 for eligible commercially insured patients.

Final Thoughts

Dapagliflozin is a highly effective medication, but if you can't fill your prescription, there are real alternatives available. Empagliflozin (Jardiance) is the closest substitute for most patients. Always work with your healthcare provider to find the right option for your specific needs.

Start by checking Medfinder for availability, and explore our other guides on Dapagliflozin drug interactions and finding a doctor who prescribes Dapagliflozin.