Dapagliflozin

# Dapagliflozin ## Overview - **Classification**: Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor - **Mechanism**: Selectively inhibits SGLT2 in the renal proximal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. Also promotes natriuresis, contributing to cardiovascular and renal benefits. ## Primary Indications 1. **Type 2 Diabetes Mellitus (T2DM)**: As an adjunct to diet and exercise to improve glycemic control. 2. **Heart Failure with Reduced Ejection Fraction (HFrEF)**: To reduce risk of cardiovascular death and hospitalization for heart failure. 3. **Chronic Kidney Disease (CKD)**: To reduce risk of kidney disease progression, ESRD, cardiovascular death, and hospitalization for heart failure. ## Adult Dosing ### Standard Dosing **Type 2 Diabetes Mellitus** - **Dose**: Start with **5 mg** - **Frequency**: Once daily, in the morning - **Route**: Oral - **Maximum Dose**: May increase to **10 mg** once daily if 5 mg is tolerated and additional glycemic control is needed. **Heart Failure with Reduced Ejection Fraction (HFrEF)** - **Dose**: **10 mg** - **Frequency**: Once daily, in the morning - **Route**: Oral - **Special Considerations**: Initiate regardless of T2DM status or HbA1c. **Chronic Kidney Disease (CKD)** - **Dose**: **10 mg** - **Frequency**: Once daily, in the morning - **Route**: Oral - **Special Considerations**: Initiate regardless of T2DM status. ### Dose Adjustments - **Renal Impairment**: - **T2DM**: Not recommended for glycemic control if eGFR **<25 mL/min/1.73m²**. - **HFrEF & CKD**: Can be initiated/continued if eGFR **≥25 mL/min/1.73m²**. - **Dialysis**: Not recommended. - **Hepatic Impairment**: No dose adjustment required. - **Elderly Patients**: No specific dose adjustment. Monitor hydration status closely. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Not applicable. - **Special Notes**: Safety and efficacy not established in pediatric patients. ### Infants (1-12 months) - **Dose**: Not applicable. - **Special Notes**: Safety and efficacy not established in pediatric patients. ### Children (1-12 years) - **Dose**: Not applicable. - **Special Notes**: Safety and efficacy not established in pediatric patients. ### Adolescents (13-18 years) - **Dose**: Not applicable. - **Special Notes**: Safety and efficacy not established in pediatric patients. ## Safety Information ### Contraindications - **Absolute**: History of serious hypersensitivity reaction to dapagliflozin. - **Absolute**: Patients on dialysis. ### Common Adverse Effects - **Very Common (>10%)**: Female genital mycotic infections (vulvovaginitis), urinary tract infections (UTIs). - **Common (1-10%)**: Nasopharyngitis, increased urination, thirst, back pain, dyslipidemia. - **Serious but Rare**: Diabetic ketoacidosis (DKA, including euglycemic DKA), severe UTIs (pyelonephritis, urosepsis), Fournier's gangrene, acute kidney injury. ### Key Drug Interactions - **Diuretics (Loop/Thiazide)**: Increased risk of volume depletion, hypotension. Monitor volume status. - **Insulin/Insulin Secretagogues**: Increased risk of hypoglycemia (when used for T2DM). May require dose reduction of insulin/secretagogues. - **Drugs affecting renal function (e.g., NSAIDs)**: Increased risk of AKI, especially in volume-depleted patients. ## Monitoring & Follow-up - **Before Treatment**: Assess renal function (eGFR) and volume status. - **During Treatment**: - Monitor renal function periodically. - Monitor for signs/symptoms of volume depletion (e.g., dizziness). - Monitor for signs/symptoms of UTIs or genital mycotic infections. - **Clinical Signs**: Watch for symptoms of DKA (e.g., nausea, vomiting, abdominal pain) even with normal blood glucose. ## Clinical Pearls - 💡 **Tip 1**: Take once daily in the morning, with or without food. - 💡 **Tip 2**: Advise patients to maintain adequate hydration, especially during illness or prolonged fasting. - 💡 **Tip 3**: Counsel patients on symptoms of genital mycotic infections, UTIs, and DKA. - 💡 **Tip 4**: Consider temporary discontinuation during acute illness, surgery, or prolonged fasting. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.