SGLT2 Inhibitor Pregnancy: Not recommended during the second and third trimesters of pregnancy (based on animal data showing adverse renal effects). Limited data in pregnant women.

Dapagliflozin

Brand names: Forxiga

Used in: Heart Failure Chronic Kidney Disease Diabetes & DKA

Dapagliflozin is an SGLT2 inhibitor used in type 2 diabetes and, independently of diabetes, in heart failure and chronic kidney disease, where it has cardiovascular and renal benefits.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 5 mg to 10 mg

Route: Oral

Frequency: Once daily

US labelling (FARXIGA); no UK SPC in bundle. To improve glycaemic control (eGFR 45 or greater): recommended starting dose 5 mg once daily, may be increased to 10 mg once daily for additional glycaemic control. For all other indications the recommended starting dose is 10 mg once daily. Not recommended to improve glycaemic control if eGFR less than 45 mL/min/1.73m2 (likely ineffective). Assess volume status and correct volume depletion before initiating. Withhold for at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting. Dose given by eGFR band — see renalAdjustment.

Dose adjustments

Renal

eGFR 45 or greater: for glycaemic control start 5 mg once daily, may increase to 10 mg; for all other indications 10 mg once daily. eGFR 25 to less than 45: 10 mg once daily. eGFR less than 25: initiation not recommended; patients may continue 10 mg once daily to reduce risk of eGFR decline, ESKD, CV death and hospitalisation for heart failure.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

• Assess volume status and correct volume depletion before initiating. (2.1) eGFR (mL/min/1.73 m 2 ) Recommended Dose eGFR 45 or greater To improve glycemic control, the recommended starting dose is 5 mg orally once daily. Dose can be increased to 10 mg orally once daily for additional glycemic control. For all other indications, the recommended starting dose is 10 mg orally once daily. eGFR 25 to less than 45 10 mg orally once daily eGFR less than 25 Initiation is not recommended; however, patients may continue 10 mg orally once daily to reduce the risk of eGFR decline, ESKD, CV death and hHF. • Withhold FARXIGA for at least 3 days, if possible, prior to major surgery or procedures …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-12-12. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

History of a serious hypersensitivity reaction to dapagliflozin, such as anaphylactic reactions or angioedema

Side effects

Female genital mycotic infections
Nasopharyngitis
Urinary tract infections
Volume depletion / hypotension
Diabetic ketoacidosis (including in type 1 diabetes and others at risk)

Interactions

Insulin or insulin secretagogues (e.g. sulfonylurea): increased risk of hypoglycaemia; may require lower doses of insulin or the secretagogue
Lithium: concomitant use with an SGLT2 inhibitor may decrease serum lithium concentrations; monitor lithium more frequently during initiation and dose changes
Positive urine glucose test and 1,5-anhydroglucitol (1,5-AG) assay: unreliable in patients on SGLT2 inhibitors; use alternative methods to monitor glycaemic control

Clinical monograph

How it works

It blocks the sodium-glucose co-transporter 2 in the proximal renal tubule, increasing urinary glucose and sodium excretion; its heart-failure and kidney benefits are only partly explained by glucose lowering.

Prescribing in practice

There is a risk of diabetic ketoacidosis, which can occur with near-normal glucose — withhold during acute illness, fasting or surgery (sick-day rules) and counsel on warning symptoms.
Genital and urinary infections and volume depletion can occur, especially with diuretics; a small early dip in eGFR is expected and not a reason to stop.
It is not relied upon for glucose lowering at low eGFR, though cardiorenal indications extend to lower eGFR thresholds.

Monitoring

Monitor renal function and volume status; remain alert to ketoacidosis symptoms regardless of blood glucose.

Counselling the patient

Follow sick-day rules — stop temporarily if you are acutely unwell, vomiting, or not eating, and seek advice.
Maintain genital hygiene and report symptoms of infection.
Seek urgent help for nausea, vomiting, abdominal pain or breathlessness even if your sugar is normal.

Evidence & guidelines

SGLT2 inhibitors are recommended in HFrEF and in CKD (e.g. DAPA-HF, DAPA-CKD) and in type 2 diabetes with cardiovascular risk, per NICE guidance.

Reference: DAPA-HF (McMurray et al, NEJM 2019); DAPA-CKD (Heerspink et al, NEJM 2020); NICE TA679; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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