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Dapagliflozin genital infection — GPhC CRA MCQ

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HardEndocrine TherapeuticsDapagliflozin genital infectionGPhC CRA

A 59-year-old taking dapagliflozin reports rapidly worsening perineal pain and swelling, fever and profound malaise. He thought it was thrush and has used clotrimazole for two days. What is the priority action?

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Correct answer: A — Stop dapagliflozin and arrange emergency assessment for possible Fournier’s gangrene

Severe perineal pain or tenderness, swelling and systemic illness in an SGLT2-inhibitor user are warning features of Fournier’s gangrene, a rare necrotising infection. MHRA advice is to stop the SGLT2 inhibitor and urgently start treatment through emergency assessment, including antibiotics and surgical management where required. Treating presumed thrush or delaying review can be catastrophic; Fournier’s gangrene may be preceded by an apparently local urogenital infection.

Reference: MHRA Drug Safety Update: SGLT2 inhibitors and Fournier’s gangrene: https://www.gov.uk/drug-safety-update/sglt2-inhibitors-reports-of-fournier-s-gangrene-necrotising-fasciitis-of-the-genitalia-or-perineum