SGLT2 Inhibitor Pregnancy: Avoid — potential effects on fetal renal development

Dapagliflozin

Brand names: Forxiga

Adult dose

Dose: 10 mg once daily

Route: Oral

Frequency: Once daily, morning

Max: 10 mg OD

DAPA-HF: HFrEF (LVEF ≤40%) regardless of diabetes status. DAPA-CKD: CKD with proteinuria. Cardiovascular and renal protective effects independent of glucose lowering.

Paediatric dose

Route: Oral

Frequency: OD

Max: Not licensed for HF/CKD in children

Licensed for T2DM ≥10 years only at 10 mg OD; not for HF/CKD in paediatric patients

Dose adjustments

Renal

For HF/CKD indication: can use down to eGFR 25. Avoid for glycaemic control if eGFR <45. Discontinue if eGFR <15.

Hepatic

Caution in severe hepatic impairment — increased exposure

Clinical pearls

DAPA-HF: 26% RRR in CV death/HF hospitalisation/worsening HF vs placebo in HFrEF
DAPA-CKD: 39% RRR in renal events in CKD (eGFR 25–75 with albuminuria)
Euglycaemic DKA can occur — suspend 3 days before major surgery
Sick-day guidance: suspend with dehydration/acute illness (infection, diarrhoea, vomiting)

Contraindications

Type 1 diabetes (DKA risk — off-label caution)
eGFR <15 (initiation)
Recurrent UTIs
Genital mycotic infections (relative)

Side effects

Genital mycotic infections (4–10%)
UTI
Diabetic ketoacidosis (DKA — even euglycaemic)
Hypotension
Fournier's gangrene (rare)
Volume depletion
Elevated creatinine (initial, transient)

Interactions

Insulin/sulfonylureas — increased hypoglycaemia risk
Diuretics — enhanced diuresis, dehydration
NSAIDs — renal risk
Lithium — monitor levels

Monitoring

eGFR and electrolytes before and during treatment
Signs of DKA (even with normal glucose)
Genital hygiene counselling
Blood pressure and volume status

Reference: BNFc; DAPA-HF (McMurray et al, NEJM 2019); DAPA-CKD (Heerspink et al, NEJM 2020); BNF; NICE TA679. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

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