Dapagliflozin
Generic Name: Dapagliflozin
Uses & Medical Indications
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus; reduction of the risk of hospitalization for heart failure in adults with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors; treatment of heart failure with reduced or preserved ejection fraction (HFrEF/HFpEF); treatment of chronic kidney disease (CKD) at risk of progression.
Type 2 Diabetes Mellitus, Heart Failure (HFrEF/HFpEF), Chronic Kidney Disease (CKD), Hypertension
Work Mechanism & Pharmacology
Patient Overview of Work Mechanism
Dapagliflozin works through the kidneys. Instead of forcing the body to use or store excess sugar, it blocks the protein in the kidneys that absorbs sugar back into the bloodstream. The excess sugar is safely flushed out of the body through the urine, effectively lowering blood sugar, reducing blood pressure, aiding weight loss, and protecting both the heart and kidneys.
Clinical Mechanism of Action (MoA)
Dapagliflozin is a highly potent, selective, and reversible inhibitor of sodium-glucose cotransporter 2 (SGLT2), the primary transporter responsible for approximately 90% of renal glucose reabsorption in the S1 segment of the proximal convoluted tubule. By blocking SGLT2, dapagliflozin reduces renal tubular glucose reabsorption, lowering the renal threshold for glucose and promoting the excretion of excess glucose (approx. 70 grams/day) and accompanying sodium in the urine. This gliflozin-mediated osmotic diuresis results in reductions in fasting and postprandial blood glucose, HbA1c, body weight, blood pressure, intraglomerular pressure, and cardiac preload/afterload, conferring substantial cardiorenal protective benefits.
Dosage & Administration Guidelines
10 mg orally once daily in the morning with or without food. For glycemic control starting dose may be 5 mg once daily in patients requiring a gentler initiation.
Safety and efficacy not established in pediatric patients under 18 years.
10 mg once daily; assess volume status prior to initiation.
10 mg once daily.
Glycemic efficacy is diminished when eGFR <45 mL/min; however, cardiorenal protective benefits persist down to eGFR 20-25 mL/min. Not recommended for glycemic initiation if eGFR <25 mL/min.
No dose adjustment in mild or moderate hepatic impairment. 5 mg starting dose in severe hepatic impairment.
Side Effects & Safety Warnings
Genital mycotic infections (yeast infections/candidiasis), urinary tract infections, increased urination (polyuria), mild hypotension, thirst.
Euglycemic diabetic ketoacidosis (DKA), Fournier gangrene (necrotizing fasciitis of perineum), acute kidney injury from volume depletion, urosepsis, pyelonephritis.
Severe hypersensitivity to dapagliflozin; patients on dialysis; treatment of type 1 diabetes mellitus (elevated DKA risk).
Assess volume status and correct hypovolemia prior to starting. Temporarily discontinue before major surgery or during acute severe medical illness to prevent ketoacidosis. Practice good genital hygiene.
Interactions (Drugs, Food & Alcohol)
Diuretics (furosemide, hydrochlorothiazide): increased risk of dehydration and hypotension. Insulin and sulfonylureas: increased hypoglycemia risk; consider lower dose.
Can be taken with or without food.
Avoid excessive alcohol intake to reduce the risk of diabetic ketoacidosis.
Identified Clinical Drug Interactions for Dapagliflozin:
Additive volume depletion, symptomatic orthostatic hypotension, and prerenal azotemia.
Pregnancy & Breastfeeding Safety
Not recommended during the second and third trimesters of pregnancy due to potential adverse effects on renal development.
Not recommended while nursing.
Patient Counseling & Practical Advice
Take once daily in the morning. Drink plenty of water throughout the day. Practice thorough daily genital hygiene to prevent yeast infections.
Take the missed dose as soon as remembered that day. Do not take two tablets the next day.
eGFR / serum creatinine, blood pressure, volume status, signs of genital or urinary tract infections, ketones if patient is acutely unwell.
Frequently Asked Questions
Related Medicines in Antidiabetic (SGLT2 Inhibitor)
When to Seek Urgent Medical Attention
Signs of euglycemic DKA (nausea, vomiting, confusion, rapid deep breathing even with normal blood glucose) or Fournier's gangrene.
Content for Dapagliflozin was synthesized from standardized public health monographs, official pharmacopoeias, and health authorities:
- American Diabetes Association (ADA) — Standards of Care - SGLT2 Inhibitor Cardiorenal Protection
- FDA — Farxiga (Dapagliflozin) Prescribing Information
The information provided on this website is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition.