Overview
Dapagliflozin is an SGLT2 inhibitor indicated for glycemic control in type 2 diabetes, cardiovascular risk reduction in patients with type 2 diabetes and established cardiovascular disease or multiple risk factors, and to reduce the risk of hospitalization for heart failure and cardiovascular death in adults with heart failure. It is also indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression.
Mechanism of Action
Dapagliflozin is a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor that reduces renal glucose reabsorption, increases urinary glucose excretion, and lowers blood glucose levels. It also promotes osmotic diuresis and modest natriuresis, contributing to cardiovascular and renal benefits.
Indications
- To reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression.
- To reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure.
- To reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors.
- As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus.
Common Doses
- 5 mg
- 10 mg
Dosage
The recommended starting dose is 10 mg once daily, taken in the morning with or without food. Dosage may be adjusted based on renal function and tolerability. For heart failure and chronic kidney disease indications, the dose is 10 mg once daily.
Contraindications
- History of serious hypersensitivity reaction to dapagliflozin or any excipients in FARXIGA.
Side Effects
- Genital mycotic infections.
- Urinary tract infections.
- Increased urination.
- Volume depletion (e.g., hypotension, dizziness).
- Hypoglycemia when used with insulin or insulin secretagogues.
- Increased serum creatinine and decreased eGFR.
- Dyslipidemia.
- Back pain.
- Nausea.
Interactions
- Concomitant use with insulin or insulin secretagogues (e.g., sulfonylureas) increases the risk of hypoglycemia; dose adjustment of insulin or secretagogue may be required.
- Concomitant use with lithium may decrease serum lithium concentrations; monitor serum lithium levels more frequently.
- SGLT2 inhibitors increase urinary glucose excretion, leading to positive urine glucose tests; use alternative methods to monitor glycemic control.
- Interferes with 1,5-anhydroglucitol (1,5-AG) assay; use alternative methods to monitor glycemic control.
Counseling Points
- Take once daily in the morning, with or without food.
- Stay hydrated to reduce the risk of volume depletion and urinary tract infections.
- Monitor for symptoms of genital yeast infections (itching, discharge) and seek treatment if they occur.
- Be aware of symptoms of ketoacidosis (nausea, vomiting, abdominal pain, fatigue, difficulty breathing) and seek medical attention if they occur, even if blood sugar is not high.
- Check blood sugar regularly as directed, especially if taking with insulin or other diabetes medications.
- Inform healthcare provider of all medications, including over-the-counter drugs and supplements.