SGLT2 Inhibitor (CKD — Renoprotective) Pregnancy: There are no data from the use of dapagliflozin in pregnant women. Studies in rats have shown toxicity to the developing kidney in the time period corresponding to the second and third trimesters of human pregnancy, therefore use is NOT RECOMMENDED during the second and third trimesters of pregnancy; when pregnancy is detected, treatment should be discontinued. Breast-feeding: it is unknown whether dapagliflozin and/or its metabolites are excreted in human milk; animal data show excretion in milk as well as pharmacologically-mediated effects in nursing offspring, and a risk to newborns/infants cannot be excluded — dapagliflozin should not be used while breast-feeding. Fertility: the effect on human fertility has not been studied; no effects on fertility were seen in male and female rats at any dose tested.

Dapagliflozin (CKD Indication)

Brand names: Forxiga

Dapagliflozin is an SGLT2 inhibitor used to slow the 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: Chronic kidney disease: the recommended dose is 10 mg dapagliflozin once daily.

Route: Oral — tablets are to be swallowed whole

Frequency: Once daily, at any time of day, with or without food

Max: 10 mg once daily is the recommended dose for all three UK indications (type 2 diabetes mellitus, heart failure, chronic kidney disease); no higher dose is stated

Source: UK SPC (eMC) for Dapagliflozin 10 mg film coated tablets, §4.2 (https://www.medicines.org.uk/emc/product/101534/smpc). OTHER INDICATIONS (same dose): type 2 diabetes mellitus — 10 mg once daily, and when used in combination with insulin or an insulin secretagogue such as a sulphonylurea, a LOWER dose of insulin or insulin secretagogue may be considered to reduce the risk of hypoglycaemia; heart failure — 10 mg once daily. HEPATIC IMPAIRMENT: no dose adjustment is necessary in mild or moderate impairment; in SEVERE hepatic impairment a starting dose of 5 mg is recommended, and if well tolerated the dose may be increased to 10 mg. ELDERLY (65 years and over): no dose adjustment is recommended based on age; caution is advised in patients for whom a dapagliflozin-induced drop in blood pressure could pose a risk, such as those on antihypertensive therapy with a history of hypotension or elderly patients. PAEDIATRIC: no dose adjustment is required for the treatment of TYPE 2 DIABETES MELLITUS in children aged 10 years and above (a fixed dose, not a per-kg dose, so paedDose is null), and no data are available for children below 10 years; the safety and efficacy of dapagliflozin for HEART FAILURE or for CHRONIC KIDNEY DISEASE in children under 18 years have NOT been established and no data are available. Verify any under-18 use against a children's formulary. VOLUME DEPLETION: dapagliflozin increases diuresis, which may lead to a modest decrease in blood pressure; in intercurrent conditions that may lead to volume depletion (e.g. gastrointestinal illness) careful monitoring of volume status is recommended (physical examination, blood pressure, laboratory tests including haematocrit and electrolytes), and TEMPORARY INTERRUPTION of treatment is recommended for patients who develop volume depletion until it is corrected. DIABETIC KETOACIDOSIS: rare cases, including life-threatening and fatal cases, have been reported with SGLT2 inhibitors including dapagliflozin, sometimes with an atypical presentation and only moderately increased blood glucose below 14 mmol/L (250 mg/dL); assess patients for ketoacidosis immediately if non-specific symptoms occur (nausea, vomiting, anorexia, abdominal pain, excessive thirst, difficulty breathing, confusion, unusual fatigue or sleepiness) REGARDLESS of blood glucose level, stop dapagliflozin immediately if DKA is suspected or diagnosed, and interrupt treatment in patients hospitalised for major surgical procedures or acute serious medical illnesses. The US label adds: withhold dapagliflozin for at least 3 days, if possible, prior to surgery or procedures associated with prolonged fasting, resuming when the patient is clinically stable and has resumed oral intake; assess renal function and volume status prior to initiation, correcting volume depletion first; if a dose is missed take it as soon as possible and do not double up the next dose. NOTE ON SOURCES: eMC §4.5 was NOT captured in this bundle — the interaction entries below come from UK §4.2 plus §7 of the US label (FARXIGA, A-S Medication Solutions, label date 2026-07-10) and must be verified against the full SPC. The eMC §4.8 adverse-reaction TABLE was truncated at the source-fetch limit before the table itself, so the side-effect list below is built from the §4.8 narrative summary plus the US §5/§6 headings — verify the full frequency table on the SPC. §4.4 was also truncated.

Dose adjustments

Renal

NO dose adjustment is required based on renal function. It is NOT recommended to INITIATE treatment in patients with an eGFR less than 15 mL/min/1.73 m2 (there is limited experience with initiation below eGFR 25 mL/min/1.73 m2 and no experience with initiation below 15 mL/min/1.73 m2). In patients with TYPE 2 DIABETES the glucose-lowering efficacy of dapagliflozin is reduced when eGFR is less than 45 mL/min/1.73 m2 and is likely absent in severe renal impairment — if eGFR falls below 45 mL/min/1.73 m2, additional glucose-lowering treatment should be considered in those patients. In patients with moderate renal impairment (eGFR less than 60 mL/min/1.73 m2) a higher proportion of dapagliflozin-treated patients had adverse reactions of increased parathyroid hormone and hypotension compared with placebo. US labelling (cross-check, differs in its thresholds): for indications OTHER than glycaemic control the recommended dosage in patients with eGFR of 25 mL/min/1.73 m2 or greater is the same as in normal renal function, initiation is NOT recommended below eGFR 25 mL/min/1.73 m2, and if eGFR falls below 25 mL/min/1.73 m2 during treatment 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 in type 2 diabetes the US label does not recommend use below an eGFR of 45 mL/min/1.73 m2. In the DAPA-CKD study the population had an eGFR of 25 to 75 mL/min/1.73 m2 and treatment was continued if eGFR fell below 25 mL/min/1.73 m2.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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

Hypersensitivity to the active substance or to any of the excipients (US labelling: history of a serious hypersensitivity reaction to dapagliflozin or any excipient — serious hypersensitivity reactions including anaphylaxis and angioedema have been reported)

Side effects

Genital infections — the most frequently reported adverse reactions across the clinical studies (UK §4.8); US labelling lists female genital mycotic infections, nasopharyngitis and urinary tract infections as the most common adverse reactions (5% or greater incidence)
Genitourinary infections including urosepsis, pyelonephritis and necrotising fasciitis of the perineum (Fournier's gangrene) — evaluate immediately any patient presenting with pain or tenderness, erythema or swelling in the genital or perineal area along with fever or malaise, and discontinue if necrotising fasciitis is suspected
Diabetic ketoacidosis, including life-threatening and fatal cases, sometimes with only moderately increased blood glucose
Volume depletion and hypotension (a higher proportion of patients with moderate renal impairment, eGFR less than 60 mL/min/1.73 m2, had adverse reactions of hypotension and of increased parathyroid hormone compared with placebo)
Hypoglycaemia when used with insulin or insulin secretagogues
The eMC §4.8 frequency table was truncated at the source-fetch limit — the full tabulated adverse-reaction list must be verified on the SPC

Interactions

Insulin or insulin secretagogues (e.g. sulphonylureas) — the risk of hypoglycaemia may be increased; concomitant use may require a lower dose of insulin or the insulin secretagogue (UK §4.2, US §7)
Lithium — concomitant use of an SGLT2 inhibitor with lithium may DECREASE serum lithium concentrations; monitor serum lithium more frequently during initiation and dosage changes (US §7)
Urine glucose tests — SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests; monitoring glycaemic control with urine glucose tests is not recommended, use alternative methods (US §7)
1,5-anhydroglucitol (1,5-AG) assay — measurements are unreliable for assessing glycaemic control in patients taking SGLT2 inhibitors; use alternative methods (US §7)
eMC §4.5 was not captured in the source bundle and must be checked on the SPC

Clinical monograph

How it works

By inhibiting sodium-glucose co-transporter 2 in the proximal tubule it increases sodium delivery to the macula densa; the resulting tubuloglomerular feedback lowers intraglomerular pressure, which underlies its renoprotective effect.

Prescribing in practice

Expect a small, reversible fall in eGFR when starting (a haemodynamic effect, not harm) — do not stop for this alone; euglycaemic diabetic ketoacidosis can occur, so advise sick-day rules and withhold during acute illness.
Genital fungal infections and volume depletion occur; there is a lower eGFR limit below which initiation is not recommended (check current prescribing references).
It is not for type 1 diabetes; rare necrotising fasciitis of the perineum (Fournier's gangrene) is reported.

Monitoring

Monitor renal function (anticipating the initial eGFR dip), volume status and blood pressure; check ketones if the patient is unwell, regardless of glucose.

Counselling the patient

Keep taking it despite a small early change in your kidney blood tests — this is expected.
Pause it during acute illness, vomiting or dehydration and seek advice (sick-day rules).
Report genital itching or discharge, or severe pain/swelling around the genitals or perineum.

Evidence & guidelines

Slows CKD progression and reduces cardiorenal and mortality outcomes with or without diabetes (DAPA-CKD; NICE TA775).

Reference: Wheeler et al. NEJM 2020 (DAPA-CKD trial); NICE NG203; MHRA SPC Forxiga; 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.

Calculators

Drugs

Empagliflozin (CKD Indication) · SGLT2 Inhibitor (CKD — Renoprotective)

Pathways