Dapagliflozin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Dapagliflozin: clinical details
Prescribing considerations
- Confirm the licensed indication and assess renal function, volume status, blood pressure and ketoacidosis risk before initiation.
- Glucose-lowering efficacy diminishes with reduced renal function, although heart and kidney effects are not dependent on glucose lowering.
- Review concurrent insulin, insulin secretagogues, diuretics, antihypertensives and lithium.
- Counsel about genital infection, hydration, foot care, ketoacidosis symptoms and interruption during acute illness or surgery.
- Experience is limited in some advanced or immunologically active kidney diseases and after organ transplantation.
Contraindications and cautions
- Hypersensitivity to dapagliflozin or a tablet excipient.
- The selected formulation contains lactose and is unsuitable for specified rare hereditary disorders of galactose handling.
- Do not use to treat type 1 diabetes because of ketoacidosis risk.
- Initiation is not recommended when eGFR is below 15 mL/min/1.73 m².
Monitoring
- Renal function before treatment and according to clinical circumstances.
- Volume status and blood pressure, especially in older people or those using diuretics.
- Blood glucose and hypoglycaemia risk when used with insulin or a sulfonylurea.
- Blood ketones during interruption for hospitalised major surgery or acute serious illness; urine ketones are less reliable.
- Lithium concentrations after dapagliflozin initiation or treatment changes when co-prescribed.
- Investigate pronounced haematocrit elevation and assess symptoms of urinary or genital infection promptly.
Clinical pharmacology
Dapagliflozin is a selective, reversible SGLT2 inhibitor. It causes glucosuria, natriuresis and osmotic diuresis, increases distal sodium delivery and tubuloglomerular feedback, and reduces intraglomerular pressure. It is mainly metabolised by UGT1A9 to an inactive glucuronide metabolite, with little CYP-mediated metabolism.
Formulation and product differences
- The selected product is a film-coated tablet intended to be swallowed whole.
- It contains lactose; tablet appearance, excipients and packaging can differ between manufacturers.
- Urinary glucose is expected during treatment and can interfere with tests that rely on urine glucose or 1,5-anhydroglucitol.
Dapagliflozin preparations and strengths
Tablet
Route: Oral
Strengths: 5 mg, 10 mg
Dapagliflozin interactions
Important medicine combinations include:
Insulin and sulfonylureas, such as gliclazide
The combination increases hypoglycaemia risk, so accompanying diabetes treatment may require clinician review.
Loop or thiazide diuretics, such as furosemide
Additive fluid loss can increase dehydration and low-blood-pressure risk.
Blood-pressure-lowering medicines
Dizziness or symptomatic low blood pressure may be more likely, particularly with dehydration.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.