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SGLT2 Inhibitor

Dapagliflozin

Brand names: Forxiga

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses 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.

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: NICE TA679; NICE TA775; DAPA-HF Trial (NEJM 2019); DELIVER Trial (NEJM 2022); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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