Formulary
Dapagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
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Dapagliflozin: Indications, Dosing, Side Effects and Interactions
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary...
Drug action
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
Indications and dose
**Type 2 diabetes mellitus [as monotherapy if metformin inappropriate],Type 2 diabetes mellitus [in combination with insulin or other antidiabetic drugs],Symptomatic chronic heart failure,Chronic kidney disease**
- **Adult** (By Mouth): 10 mg once daily.
**Type 2 diabetes mellitus [as monotherapy if metformin inappropriate], Type 2 diabetes mellitus [in combination with insulin or other antidiabetic drugs] for dapagliflozin**
- **Child 10-17 years** (By mouth): 10 mg once daily.
Cautions
Elderly; hypotension; risk of volume depletion Cautions, further information Volume depletion Correct hypovolaemia before starting treatment.
Contraindications
Diabetic ketoacidosis; type 1 diabetes mellitus (increased risk of diabetic ketoacidosis)
Side effects
Common or very common Back pain; balanoposthitis; cystitis; dizziness; dyslipidaemia; hypoglycaemia (in combination with insulin or sulfonylurea); increased risk of infection; prostatitis; skin reactions; urinary disorders; vulvovaginal disorders Uncommon Constipation; dry mouth; fluid imbalance; genital pruritus; hypotension; thirst; weight decreased Rare or very rare Angioedema; diabetic ketoacidosis (discontinue immediately); Fournier's gangrene (discontinue and initiate treatment promptly); nephritis tubulointerstitial Side-effects, further information Volume depletion Interrupt treatment if volume depletion occurs. Urinary tract infections Urinary glucose excretion may be associated with an increased risk of urinary tract infection. Consider temporarily interrupting treatment with dapagliflozin when treating pyelonephritis or urosepsis. Renal function changes Creatinine levels may increase during initial treatment. These increases in creatinine are generally transient with continued treatment or reversible after stopping treatment.
Interactions
**Other interactions (14):**
- Pharmacodynamic interactions Diuretics Dapagliflozin may add to the diuretic effect of thiazide and loop diuretics and may increase the risk of dehydration and hypotension (see section 4.4).
- Insulin and insulin secretagogues Insulin and insulin secretagogues, such as sulphonylureas, cause hypoglycaemia.
- Therefore, a lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with dapagliflozin in patients with type 2 diabetes...
- Pharmacokinetic interactions The metabolism of dapagliflozin is primarily via glucuronide conjugation mediated by UDP glucuronosyltransferase 1A9 (UGT1A9).
- In in vitro studies, dapagliflozin neither inhibited cytochrome P450 (CYP) 1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, nor induced CYP1A2, CYP2B6 or CYP3A4.
- Effect of other medicinal products on dapagliflozin Interaction studies conducted in healthy subjects, using mainly a single-dose design, suggest that the pharmacokinetics of dapagliflozin are not...
Pregnancy
Avoid-toxicity in animal studies.
Breast feeding
Avoid-present in milk in animal studies.
Hepatic impairment
Caution in severe impairment (risk of increased exposure; limited information available). M Dose adjustments Initially 5 mg daily in severe impairment, increased if tolerated to 10 mg daily. M
Renal impairment
Prescribing in renal impairment . Avoid initiation if eGFR less than 15 mL/minute/1.73 m 2 . M When used for Type 2 diabetes mellitus: Consider additional antidiabetic drugs with dapagliflozin if eGFR less than 45 mL/minute/1.73 m 2 (reduced efficacy). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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