Dapagliflozin: Complete and Detailed Guide with FAQs
Introduction
- Dapagliflozin is an oral anti-diabetic medication belonging to the Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitor class.
- Primarily used to manage Type 2 Diabetes Mellitus (T2DM), it also offers benefits for heart failure and chronic kidney disease (CKD).
- Works by promoting glucose excretion through urine, improving blood sugar levels and reducing complications.
Class and Mechanism of Action
- Drug Class: Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitor.
- Mechanism:
- Inhibits SGLT-2 proteins in the kidneys, reducing glucose reabsorption.
- Increases glucose excretion in urine, lowering blood sugar levels.
- Also reduces body weight and blood pressure due to fluid and calorie loss.
Indications
- Type 2 Diabetes Mellitus (T2DM): Improves glycemic control in combination with diet and exercise.
- Heart Failure with Reduced Ejection Fraction (HFrEF): Reduces the risk of hospitalization and cardiovascular death.
- Chronic Kidney Disease (CKD): Slows progression of renal dysfunction and reduces cardiovascular risks.
Dosage and Administration
- Formulation: Oral tablets (5 mg, 10 mg).
Typical Dosage
- T2DM: Start with 5 mg once daily; may increase to 10 mg once daily based on response.
- HFrEF or CKD: 10 mg once daily.
Administration Guidelines
- Take with or without food.
- Ensure adequate hydration to reduce the risk of dehydration.
- Avoid use in severe kidney impairment (eGFR <30 mL/min/1.73 m²).
Forms, Brand Names, Manufacturers, and Prices
- Brand Names: Farxiga (AstraZeneca).
- Price: ~$400–$500 per month (prices vary regionally and by insurance).
- Availability: Generic versions may reduce costs in some regions.
Contraindications and Precautions
- Contraindications:
- Severe kidney impairment or dialysis.
- History of hypersensitivity to dapagliflozin or excipients.
- Active bladder cancer (use with caution).
- Precautions:
- Monitor for signs of diabetic ketoacidosis (DKA), especially in low-carb diets or insulin-reduced regimens.
- Increased risk of urinary and genital infections.
- Avoid during severe dehydration or hypotension.
Side Effects
Common Side Effects
- Increased urination.
- Genital infections (e.g., yeast infections).
- Urinary tract infections (UTIs).
Less Common Side Effects
- Dizziness or dehydration.
- Mild reduction in blood pressure.
Rare but Serious Side Effects
- Diabetic ketoacidosis (DKA) in the absence of high blood sugar.
- Acute kidney injury (rare in well-hydrated patients).
- Fournier’s gangrene (necrotizing fasciitis of the perineum).
Drug Interactions
- Diuretics: Increased risk of dehydration and hypotension.
- Insulin or Sulfonylureas: Higher risk of hypoglycemia; dose adjustments may be needed.
- Rifampin or Phenytoin: May reduce dapagliflozin effectiveness due to enzyme induction.
Monitoring Parameters
- Blood glucose levels (HbA1c and fasting glucose).
- Kidney function tests (eGFR, creatinine).
- Signs of dehydration or electrolyte imbalances.
- Monitoring for UTIs or genital infections.
Patient Counseling Points
- Take once daily at the same time for consistent blood sugar control.
- Maintain adequate fluid intake to avoid dehydration.
- Monitor for signs of infection, such as fever, painful urination, or unusual discharge.
- Recognize symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain) and seek medical attention immediately.
- Inform your doctor if planning surgery or significant dietary changes.
Use in Children
- Not approved for pediatric use.
Use in Pregnancy
- Not recommended during pregnancy due to potential risks to fetal kidney development.
- Consider insulin or other safer alternatives for glycemic control.
Use in Elderly
- Use cautiously due to higher risks of dehydration and hypotension.
- Regularly monitor kidney function.
FAQs About Dapagliflozin
Q1: What is dapagliflozin used for?
- It is used to manage Type 2 Diabetes Mellitus, heart failure, and chronic kidney disease.
Q2: Can dapagliflozin cause hypoglycemia?
- It rarely causes hypoglycemia alone but increases risk when combined with insulin or sulfonylureas.
Q3: How does dapagliflozin benefit heart failure?
- It reduces fluid overload and improves heart function, lowering hospitalization and mortality risks.
Q4: What are common side effects of dapagliflozin?
- Increased urination, genital infections, and urinary tract infections are the most common.
Q5: Is dapagliflozin safe for kidney disease patients?
- Yes, for moderate CKD, but not recommended in severe kidney impairment (eGFR <30 mL/min/1.73 m²).
Q6: How should I store dapagliflozin?
- Store at room temperature (20–25°C) away from moisture and light.
Q7: Can I drink alcohol while taking dapagliflozin?
- Limit alcohol, as it can increase the risk of dehydration and hypoglycemia.
Q8: How soon does dapagliflozin start working?
- Blood sugar reductions can be seen within a week, with long-term benefits over months.
Q9: Can dapagliflozin cause weight loss?
- Yes, modest weight loss is a common benefit due to calorie loss through glucose excretion.
Q10: What should I do if I miss a dose?
- Take it as soon as you remember unless it’s close to the next dose. Do not double up.
Q11: Can dapagliflozin be taken with other diabetes medicines?
- Yes, it is often combined with other drugs, but requires careful monitoring to avoid hypoglycemia.
Q12: Is dapagliflozin suitable for Type 1 diabetes?
- It is not approved for Type 1 diabetes due to a high risk of diabetic ketoacidosis.
Q13: How does dapagliflozin compare to empagliflozin?
- Both are SGLT-2 inhibitors with similar efficacy, though individual tolerability may vary.
Q14: Are there alternatives to dapagliflozin?
- Other SGLT-2 inhibitors like empagliflozin (Jardiance) or canagliflozin (Invokana) may be used.
Q15: What are the warning signs of diabetic ketoacidosis?
- Symptoms include nausea, vomiting, abdominal pain, rapid breathing, and confusion. Seek immediate medical care.