Dapagliflozin
Dapagliflozin is an SGLT2 inhibitor for type 2 diabetes, heart failure, and chronic kidney disease.
About Dapagliflozin
Dapagliflozin is a sodium-glucose cotransporter 2 (sglt2) inhibitor also known by the brand name Farxiga. It is primarily used for Type 2 diabetes mellitus glycemic control, Heart failure with reduced ejection fraction, Chronic kidney disease progression prevention, and Cardiovascular risk reduction in diabetes, among other conditions. Dapagliflozin is available in oral tablet (5 mg, 10 mg), combination tablet with metformin extended-release (xigduo xr: 2.5/1000, 5/500, 5/1000, 10/500, 10/1000 mg), combination tablet with saxagliptin (qtern: 5/5, 10/5 mg), and combination tablet with saxagliptin and metformin xr (qternmet xr) form. Healthcare providers commonly prescribe Dapagliflozin for conditions including Diabetes Mellitus, Congestive Heart Failure, and Chronic Kidney Disease (CKD).
Dapagliflozin at a Glance
- Brand names
- Farxiga
- Drug class
- Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor
- Pregnancy category
- Not assigned a legacy letter (post-2015 labeling). Avoid use in the second and third trimesters because SGLT2 inhibition has caused adverse renal development in animal studies during the period corresponding to human renal maturation. Discontinue dapagliflozin when pregnancy is recognized and use insulin for glycemic control during pregnancy.
- Available forms
- Oral tablet (5 mg, 10 mg), Combination tablet with metformin extended-release (Xigduo XR: 2.5/1000, 5/500, 5/1000, 10/500, 10/1000 mg), Combination tablet with saxagliptin (Qtern: 5/5, 10/5 mg), Combination tablet with saxagliptin and metformin XR (Qternmet XR)
- Therapeutic categories
- Endocrine, Diabetes, SGLT2 Inhibitors, Cardiovascular, Nephrology
- Conditions treated
- 3 related conditions on this site
What Dapagliflozin Is Used For
- Type 2 diabetes mellitus glycemic control
- Heart failure with reduced ejection fraction
- Chronic kidney disease progression prevention
- Cardiovascular risk reduction in diabetes
- Reducing hospitalization for heart failure
Dosage Quick Reference
These are general dosage guidelines for Dapagliflozin. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Type 2 diabetes (glycemic control) | 5 mg orally once daily in the morning | 5–10 mg once daily; max 10 mg/day |
| Heart failure (HFrEF and HFpEF) | 10 mg orally once daily | 10 mg once daily |
| Chronic kidney disease (eGFR ≥ 25 mL/min/1.73 m²) | 10 mg orally once daily | 10 mg once daily |
| Patients with hepatic impairment (severe) | 5 mg once daily; consider risk-benefit | 5 mg once daily |
Side Effects
Common Side Effects:
- Genital yeast infections (more common in women)
- Urinary tract infections
- Increased urination and thirst
- Back pain
- Nasopharyngitis
- Nausea and constipation
Serious Side Effects (seek immediate medical attention):
- Signs of diabetic ketoacidosis (nausea, vomiting, abdominal pain, unusual fatigue, difficulty breathing)
- Severe genital or perineal pain, tenderness, swelling, or redness (Fournier's gangrene)
- Signs of severe dehydration or low blood pressure (dizziness, lightheadedness, weakness)
- Signs of kidney problems (decreased urination, swelling in legs)
- Severe allergic reactions
See also: Drug Interactions ↓
Drug Interactions
Dapagliflozin works on the kidney and has fewer pharmacokinetic interactions than many other diabetes drugs, but several pharmacodynamic combinations require attention.
- Insulin and insulin secretagogues (sulfonylureas, glinides): Adding dapagliflozin to insulin or a sulfonylurea increases hypoglycemia risk. Anticipate a 10–25 percent reduction in insulin or sulfonylurea dose at initiation, and monitor blood glucose closely.
- Loop and thiazide diuretics (e.g., furosemide, hydrochlorothiazide): Additive volume depletion may cause hypotension, dizziness, and acute kidney injury, especially in older adults. Reassess diuretic need; reduce diuretic dose if appropriate before starting dapagliflozin.
- ACE inhibitors, ARBs, and aldosterone antagonists: Generally compatible and often used together for cardiorenal protection, but combined RAAS blockade can transiently lower eGFR and raise potassium. Recheck renal function and electrolytes 2–4 weeks after starting.
- Lithium: Dapagliflozin may decrease lithium levels via increased renal clearance. Monitor lithium concentrations.
- Strong CYP3A4 inducers (e.g., rifampin): May modestly reduce dapagliflozin exposure; clinical significance is limited but monitor glucose response.
- Drugs causing dehydration (e.g., aggressive bowel preps, NSAIDs in volume-depleted patients): Increase risk of acute kidney injury when combined with SGLT2 inhibitors.
See also: Questions to Ask Your Doctor ↓
Key Considerations
Known drug interactions
Dapagliflozin has documented interactions with other medications, supplements, and certain foods. Review the Drug Interactions section below and tell your healthcare provider about every medication you take, including over-the-counter products. Jump to section →
Multiple forms available
Dapagliflozin comes in more than one form (Oral tablet (5 mg, 10 mg), Combination tablet with metformin extended-release (Xigduo XR: 2.5/1000, 5/500, 5/1000, 10/500, 10/1000 mg), Combination tablet with saxagliptin (Qtern: 5/5, 10/5 mg), Combination tablet with saxagliptin and metformin XR (Qternmet XR)). The right form for you depends on your condition, ease of use, and your provider's recommendation.
Additional Information
Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that has revolutionized the treatment of type 2 diabetes, heart failure, and chronic kidney disease. By blocking glucose reabsorption in the kidneys, it provides multiple cardiometabolic benefits beyond glucose control, including cardiovascular protection, renal preservation, and modest weight loss.
Mechanism of Action
Dapagliflozin selectively inhibits SGLT2, the primary transporter responsible for reabsorbing approximately 90% of filtered glucose in the proximal renal tubule. By blocking this transporter, dapagliflozin causes the excretion of approximately 70 grams of glucose per day in the urine, lowering blood glucose levels through an insulin-independent mechanism. This glucosuria also results in an osmotic diuresis and natriuresis, which contributes to blood pressure reduction and volume effects that benefit heart failure patients.
Beyond glucose effects, SGLT2 inhibition provides cardiorenal protection through multiple mechanisms including improved cardiac energetics, reduced preload and afterload, decreased inflammation, and favorable effects on kidney hemodynamics that reduce hyperfiltration and slow progression of kidney disease.
Available Formulations
Dapagliflozin (Farxiga) is available as tablets in 5 mg and 10 mg strengths. It is also available in fixed-dose combinations with metformin (Xigduo XR) and saxagliptin (Qtern) for patients requiring combination therapy for diabetes management.
FDA-Approved Indications
Dapagliflozin has received FDA approval for multiple conditions, reflecting its broad cardiometabolic benefits. These indications include improving glycemic control in adults with type 2 diabetes mellitus, reducing the risk of hospitalization for heart failure in adults with type 2 diabetes and cardiovascular disease or multiple cardiovascular risk factors, reducing the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure with reduced ejection fraction (HFrEF), and reducing the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression.
Dosing Guidelines
For type 2 diabetes, the recommended dose is 10 mg once daily in the morning, taken with or without food. For heart failure, the dose is 10 mg once daily. For chronic kidney disease, the dose is also 10 mg once daily. No dose adjustment is needed for mild to moderate hepatic impairment. The medication should be initiated only when eGFR is 25 mL/min/1.73m² or higher, though it may be continued at lower levels once started.
Clinical Trial Evidence
The cardiovascular and renal benefits of dapagliflozin have been demonstrated in landmark clinical trials. The DECLARE-TIMI 58 trial showed reduced hospitalization for heart failure in patients with type 2 diabetes. The DAPA-HF trial demonstrated significant reductions in cardiovascular death and heart failure hospitalization in patients with HFrEF, regardless of diabetes status. The DAPA-CKD trial showed remarkable renal protection in patients with chronic kidney disease, leading to early trial termination due to overwhelming efficacy.
Important Safety Considerations
While generally well-tolerated, dapagliflozin carries important safety considerations. Diabetic ketoacidosis, including euglycemic DKA with normal glucose levels, can occur and requires heightened awareness. Genital mycotic infections (yeast infections) are common due to glucosuria. Rare but serious cases of necrotizing fasciitis of the perineum (Fournier's gangrene) have been reported. Volume depletion and hypotension may occur, particularly in elderly patients or those on diuretics. Patients should be educated about these risks and advised to maintain adequate hydration.
Choosing Dapagliflozin Over Other Diabetes and Heart Failure Drugs
Dapagliflozin and empagliflozin are near-interchangeable in practice; both carry heart failure and kidney indications, and the choice usually comes down to formulary coverage. For type 2 diabetes, the American Diabetes Association's Standards of Care recommend an SGLT2 inhibitor independent of A1c for patients with established cardiovascular disease, congestive heart failure, or chronic kidney disease, and that is where dapagliflozin is chosen ahead of a DPP-4 inhibitor such as sitagliptin or a sulfonylurea. It is typically added to metformin rather than replacing it. When weight loss is the priority, a GLP-1 receptor agonist such as semaglutide lowers A1c and weight more, and the two classes are often combined in patients with both cardiovascular and kidney risk.
In heart failure it is one of the four pillars of guideline-directed therapy alongside a beta-blocker, a mineralocorticoid receptor antagonist such as spironolactone, and an ARNI or ACE inhibitor, and it is prescribed whether or not the patient has diabetes. The NHLBI heart failure overview and the MedlinePlus dapagliflozin monograph cover the indications in patient terms.
The First Weeks and What Is Monitored
Urination increases for the first several days and then settles. Patients who start it alongside a loop diuretic such as furosemide often need a diuretic dose reduction, and lightheadedness on standing in the first two weeks is the signal to look for. A small, early drop in eGFR is expected and reflects the hemodynamic effect rather than kidney injury; it stabilizes and should not by itself prompt stopping the drug. Kidney function and potassium are checked before starting and again within the first few weeks, then at routine intervals.
Two practical rules prevent most serious problems. First, the drug is held on sick days of vomiting, poor oral intake, or fasting, and for several days before surgery, because ketoacidosis in SGLT2 users can occur with a near-normal glucose, as the MedlinePlus dapagliflozin monograph describes. Second, genital hygiene and prompt treatment of yeast infections with a topical antifungal or a single dose of oral fluconazole keep most patients on therapy. Our endocrine and cardiovascular teams coordinate the dose changes to companion drugs.
Drug Interactions and Monitoring
Diuretics may increase the risk of volume depletion when combined with dapagliflozin. Insulin and insulin secretagogues may need dose reduction to prevent hypoglycemia. Regular monitoring of renal function, potassium, and volume status is recommended. Patients should be counseled about symptoms of ketoacidosis and instructed to hold the medication during periods of reduced oral intake or acute illness.
Learn more at MedlinePlus
Frequently Asked Questions
Questions to Ask Your Doctor About Dapagliflozin
Consider discussing these topics at your next appointment:
- Given my kidney function, am I a candidate for dapagliflozin and what eGFR would prompt us to stop it?
- Should my diuretic or insulin dose be reduced when I start this medication?
- When should I check ketones, and what symptoms warrant an emergency visit?
- How will we monitor whether dapagliflozin is helping my heart or kidneys, not just my blood sugar?
Questions About Dapagliflozin?
Your primary care doctor in St. Petersburg can review Dapagliflozin alongside everything else you take, check for interactions, and adjust your plan as your health changes.
Request an appointmentMedical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.