Diabetes agents · Endocrine
Dapagliflozin
Forxiga® · Farxiga®(brand names vary by market)
A glucose drug that turned out to be a heart and kidney drug.
Mechanism
Blocks SGLT2 in the proximal tubule so filtered glucose is excreted rather than reabsorbed. The cardiorenal benefit is only partly explained by that: restored tubuloglomerular feedback and reduced intraglomerular pressure carry much of it.
Indications
- Type 2 diabetes
- Heart failure across the ejection fraction range
- Chronic kidney disease, with or without diabetes
Formulations
Dosing concepts
Not a glucose-only decision
It is started for heart failure and chronic kidney disease in people who do not have diabetes at all, at the same dose. Thinking of it as a diabetes drug misses most of its indications.
Initial eGFR dip
A fall in eGFR of up to about 10 percent in the first weeks is expected haemodynamics and reverses; it is not a reason to stop, and the long-term slope is better for it.
Sick days
Held during acute illness, dehydration, or fasting before surgery, because of the ketoacidosis risk.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~78%
- Half-life
- ~12.9 h
- Elimination
- hepatic: Mainly UGT1A9 glucuronidation; glycosuric effect diminishes at low eGFR while the cardiorenal benefit persists
- Protein binding
- ~91%
Adverse effects
- Genital mycotic infectioncommonThe commonest reason patients stop; largely preventable with hygiene advice given up front.
- Volume depletion and hypotensioncommon
- Euglycemic diabetic ketoacidosisseriousKetoacidosis with a normal or near-normal glucose: the diagnosis is missed precisely because the glucose looks reassuring.
- Urinary tract infectioncommon
- Fournier gangreneseriousVery rare, rapidly progressive perineal infection.
Contraindications & precautions
Contraindications
- Type 1 diabetes, outside specialist use
- Diabetic ketoacidosis
Precautions
- Recurrent genital infections
- Volume depletion or concurrent diuretics
- Very low carbohydrate diets
- Peri-operative period
Interactions
Monitoring
Renal function
Baseline, after the expected initial dip, then routinely · Baseline, 2 to 4 weeks, then periodically
Volume status, especially alongside a loop diuretic
The two are additive and the diuretic often needs reducing
Genital and urinary symptoms
Common, treatable, and a frequent silent reason for stopping
Ketones if unwell, regardless of glucose
Euglycemic ketoacidosis
Counselling points
- Keep the genital area clean and dry, and tell us about itching or discharge early: it is treatable and not a reason to stop.
- Drink normally; do not deliberately restrict fluids.
- Stop it and contact us if you are vomiting, not eating, or seriously unwell.
- Tell your surgical team: it is usually held for a few days before an operation.
- You may pass more urine at first.
Clinical pearls
- Euglycemic ketoacidosis is the exam favourite and the real-world trap: a patient on an SGLT2 inhibitor who is unwell and acidotic needs ketones checked even with a glucose of 8.
- When it is added to a patient on a loop diuretic, the diuretic dose frequently needs to come down. Not anticipating that produces a preventable episode of dizziness and AKI.
References & review
- Dapagliflozin product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.