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, Farxiga

Dapagliflozin is an oral SGLT2 inhibitor licensed to slow progression of chronic kidney disease and reduce cardiorenal events, in patients with or without type 2 diabetes.

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: 10 mg

Route: Oral

Frequency: Once daily

US labelling (FARXIGA); no UK SPC in bundle. Chronic kidney disease / non-glycaemic indications: recommended starting dose is 10 mg once daily. eGFR 25 to less than 45: 10 mg once daily. eGFR less than 25: initiation is not recommended; however patients may continue 10 mg once daily to reduce the risk of eGFR decline, ESKD, CV death and hospitalisation for heart failure. (For glycaemic control at eGFR 45 or greater the starting dose is 5 mg once daily, increasable to 10 mg.) Assess volume status and correct volume depletion before initiating. Withhold for at least 3 days, if possible, prior to major surgery or prolonged fasting.

Dose adjustments

Renal

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. 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.

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.

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

By inhibiting SGLT2 in the proximal tubule it increases urinary glucose and sodium loss, and the consequent reduction in intraglomerular pressure via tubuloglomerular feedback slows decline in kidney function.

Prescribing in practice

Counsel on diabetic ketoacidosis, which can present with only modestly raised glucose; apply sick-day rules and withhold during acute illness, dehydration or surgery.
Expect a small reversible dip in eGFR on starting, which is not a reason to stop; benefit extends to low eGFR though glucose-lowering effect diminishes.
Genital mycotic and urinary infections and volume depletion are common; rare necrotising fasciitis of the perineum (Fournier's gangrene) warrants urgent assessment of severe genital pain or swelling.

Monitoring

Monitor renal function and volume status, and reinforce ketoacidosis awareness, particularly during intercurrent illness.

Counselling the patient

Pause the tablet and seek advice if you become acutely unwell, dehydrated or are not eating and drinking.
Maintain genital hygiene and report any thrush or urinary symptoms.
A small early fall in kidney blood tests is expected and the medicine still protects your kidneys.

Evidence & guidelines

The DAPA-CKD trial demonstrated that dapagliflozin reduced the risk of kidney failure, cardiovascular death and worsening renal function in CKD, with and without type 2 diabetes.

Reference: DAPA-CKD trial (NEJM 2020); NICE TA775; 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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