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SGLT2 Inhibitor Pregnancy: D — avoid (risk to foetal kidneys)

Dapagliflozin

Brand names: Forxiga, Farxiga

Adult dose

Dose: 10mg once daily

Route: Oral

Frequency: Once daily

Indicated for CKD (eGFR 25–75) with or without T2DM. Also indicated for heart failure (HFrEF and HFpEF).

Clinical pearls

DAPA-CKD trial: 39% reduction in CKD progression, CV death, or hospitalisation
Benefit is largely independent of diabetes status — works in non-diabetic CKD
Hold during acute illness, surgery, and contrast — risk of AKI/DKA
Mechanism: reduces intraglomerular pressure via tubuloglomerular feedback
Initial eGFR dip on starting is expected and benign — does not indicate harm

Contraindications

eGFR <25 mL/min/1.73m² (CKD indication)
Type 1 diabetes
Recurrent DKA
Dialysis

Side effects

Genital mycotic infections
UTI
Polyuria
Euglycaemic DKA (rare)
Volume depletion
Lower limb amputations (class effect, less with dapagliflozin)

Interactions

Diuretics — additive volume depletion
Insulin/sulfonylureas — hypoglycaemia risk

Monitoring

eGFR and serum creatinine (before starting, after initiation)
Urinalysis (infection symptoms)
Glycaemia (in T2DM)

Reference: DAPA-CKD trial (NEJM 2020); NICE TA775. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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