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SGLT2 Inhibitor Pregnancy: Contraindicated. Stop before pregnancy or as soon as pregnancy confirmed.

Dapagliflozin

Brand names: Forxiga

Adult dose

Dose: Type 2 DM: 10mg OD. Heart failure (HFrEF/HFpEF): 10mg OD. CKD (eGFR 25–75): 10mg OD
Route: Oral
Frequency: Once daily (with or without food)
Max: 10mg OD
NICE TA679: dapagliflozin for HFrEF (add to standard therapy). NICE TA775: dapagliflozin for HFpEF. Withhold for 3 days before major surgery. For HF/CKD indications, can be used in Type 1 DM under specialist supervision (unlicensed).

Paediatric dose

Route: Oral
Frequency: Once daily
Max: Not applicable
Not licensed under 18 years. Seek specialist opinion.

Dose adjustments

Renal

Type 2 DM indication: do not initiate if eGFR <45; stop if eGFR <45 (glucose-lowering). CKD/HF indications: initiate eGFR ≥25; continue even if eGFR falls below 25 (disease-modifying benefit).

Hepatic

Mild-moderate: no dose adjustment. Severe: use with caution (limited data — higher systemic exposure).

Clinical pearls

  • DAPA-HF trial: 10mg OD reduced CV death and worsening HF by 26% in HFrEF — now standard of care across cardiorenal disease
  • DELIVER trial: 10mg OD also reduced CV death/worsening HF in HFpEF — SGLT2i are the first drug class to show benefit across the full HF spectrum
  • Sick day rules: withhold if vomiting, diarrhoea, nil by mouth — euglycaemic DKA (check blood ketones; glucose may be normal)
  • SGLT2 inhibitors reduce HbA1c by 0.5–1% but are now prescribed primarily for cardiorenal protection regardless of glycaemia

Contraindications

  • Type 1 DM (euglycaemic DKA risk — specialist use only)
  • eGFR <25 for diabetes indication
  • Hypersensitivity to dapagliflozin
  • Recurrent DKA

Side effects

  • Genital mycotic infections
  • UTI
  • Polyuria
  • Volume depletion
  • Euglycaemic DKA
  • Hypotension

Interactions

  • Diuretics, antihypertensives — additive hypotension
  • Insulin/sulphonylureas — hypoglycaemia risk
  • Rifampicin — reduced efficacy

Monitoring

  • eGFR and U&E (3–6 monthly)
  • Blood pressure
  • Symptoms of volume depletion
  • HbA1c (if used for diabetes)
  • Ketones when unwell

Reference: BNFc; BNF 90; NICE TA679; NICE TA775; DAPA-HF Trial (NEJM 2019); DELIVER Trial (NEJM 2022). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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