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Signs of dehydration (dark urine, dizziness, reduced urine output) should prompt cessation of use and medical review

The practical approach is simple

The pre-specified analyses of heart failure patients from the SELECT trial revealed a reduction in major adverse cardiovascular events, improved mortality, and heart failure outcomes, however, only 31.4 % of these nondiabetic patients had an established HFrEF diagnosis and majority of them (89.9 %) were classified as NYHA class I or II, reflecting a relatively less symptomatic population [7]

Providers typically monitor response over time using symptoms, labs when appropriate, and safety assessments according to clinical guidance