Dapagliflozin works by blocking the Sodium-glucose co-transporter 2 (SGLT2). This transporter, found in the kidney’s proximal tubules, normally reabsorbs most of the filtered glucose back into the bloodstream. By inhibiting SGLT2, dapagliflozin decreases glucose reabsorption, lowers the renal threshold for glucose (RTG), and increases the amount of glucose excreted in the urine.Dapagliflozin works by blocking the Sodium-glucose co-transporter 2 (SGLT2). This transporter, found in the kidney’s proximal tubules, normally reabsorbs most of the filtered glucose back into the bloodstream. By inhibiting SGLT2, dapagliflozin decreases glucose reabsorption, lowers the renal threshold for glucose (RTG), and increases the amount of glucose excreted in the urine.

Adults: The recommended starting dose of Dapagliflozin is 5 mg once daily, taken in the morning, with or without food. In patients tolerating Dapagliflozin 5 mg once daily who require additional glycemic control, the dose can be increased to 10 mg once daily. Patients with Renal Impairment: Assessment of renal function is recommended prior to initiation of Dapagliflozin therapy and periodically thereafter. Dapagliflozin should not be initiated in patients with an eGFR less than 60 mL/min/1.73 m . No dose adjustment is needed in patients with mild renal impairment (eGFR of 60 mL/min/1.73 m or greater). Dapagliflozin should be discontinued when eGFR is persistently less than 60 mL/min/1.73 m .

Children: The safety and efficacy of Dapagliflozin in children and adolescents (<18 years) have not been established.

Dapagliflozin may interact with other medications and enhance the diuretic effect of thiazide and loop diuretics, increasing the risk of dehydration and low blood pressure. Insulin and insulin secretagogues, such as sulphonylureas, can cause hypoglycemia; therefore, their doses may need to be reduced when used with dapagliflozin to lower this risk. Dapagliflozin may also interact with antihypertensive drugs, Pioglitazone, agents that affect kidney function (such as ACE inhibitors and Angiotensin II receptor antagonists), GLP-1 agonists, Valsartan, Rifampin, and Mefenamic acid.

This medication should not be used in patients who are allergic to Dapagliflozin or any of its inactive ingredients. It is also contraindicated in individuals with severe kidney impairment, End-stage Renal Disease, or those undergoing dialysis.

The most common side effects of Dapagliflozin include low blood pressure, Ketoacidosis, acute kidney injury and reduced kidney function, urosepsis and Pyelonephritis, hypoglycemia when used together with insulin or insulin secretagogues, genital fungal infections, increased levels of low-density lipoprotein cholesterol (LDL-C), nasopharyngitis, urinary tract infections, and bladder cancer.

Dapagliflozin is classified as pregnancy category C. There are no sufficient, well-controlled studies on its use in pregnant women. It should only be used during pregnancy if the expected benefits outweigh the potential risks to the fetus. It is not known whether dapagliflozin passes into human breast milk; therefore, it should not be used during breastfeeding

Hypotension: Before starting Dapagliflozin, evaluate the patient’s fluid status and correct low blood volume, especially in elderly patients, those with kidney impairment, low systolic blood pressure, or those using diuretics. Monitor for related signs and symptoms during treatment.

Impairment in renal function: Kidney function should be regularly monitored during therapy.

Hypoglycemia: In patients using insulin or insulin secretagogues along with dapagliflozin, consider reducing their doses to minimize the risk of hypoglycemia.

Bladder Cancer: An increased occurrence of bladder cancer was noted in clinical trials. Dapagliflozin should be avoided in patients with active bladder cancer and used cautiously in those with a past history of Bladder Cancer

Macrovascular outcomes: There is no conclusive clinical evidence showing that dapagliflozin or any other antidiabetic drug reduces macrovascular risk.

Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors

Store in a cool and dry place below 30°C, protected from light. Keep out of the reach of children.