Drug reference

Dapagliflozin

Sodium-glucose cotransporter 2 (SGLT2) inhibitor (gliflozin) · Antidiabetic

Also known as Dapagliflozin propanediol, Forxiga, Farxiga, Oxra

START

10 mg OD taken in the morning; check baseline eGFR, volume status, BP; ensure patient can maintain adequate hydration

TYPICAL MAX

10 mg/day (no dose escalation)

STOP IF

eGFR <15 mL/min, signs of DKA (nausea, vomiting, abdominal pain, Kussmaul breathing), severe volume depletion, Fournier's gangrene

WATCH

eGFR at baseline and periodically, volume status/BP, signs of genital infection, ketones if ill or peri-surgical, HbA1c at 3-6 months

CDSCO approvedSchedule H (Prescription drug under Indian law). Ensure this aligns with local drug control authorities. However, most modern drugs are Schedule H. For clarity, it's a prescription-only drug in India. Based on general knowledge, it falls under Schedule H in India, requiring a prescription from a registered medical practitioner. Some modern drugs may also fall under Schedule H1 if they have potential for abuse or resistance, but SGLT2 inhibitors are generally Schedule H. I will stick with 'Schedule H'.ATC A10BK01

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 23min · absorption onset
PEAK: 1.5h · Peak plasma concentration
t½: 12.9h · Half-life supports once-daily dosing
DURATION: 1d · 24-hour SGLT2 inhibition

EXCRETION

Urine (75%, as metabolites)

route + CYP

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Avoid in second and third trimesters; animal studies show renal developmental toxicity; limited data in first trimester

FDA category + note

Top interactionssee all 6 →

GatifloxacinSevereDatabaseDDInter

Available in India

263 branded formulations and 39 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Mechanism

Selective inhibition of SGLT2 in proximal renal tubule, reducing renal glucose reabsorption and promoting urinary glucose excretion (glycosuria). This results in insulin-independent glucose lowering, osmotic diuresis, natriuresis, and modest weight loss. Cardiac benefits likely mediated by improved cardiac energetics, reduced preload/afterload, and anti-fibrotic effects.

Indications

Type 2 diabetes mellitus (monotherapy or combination)Heart failure with reduced ejection fraction (HFrEF)Heart failure with preserved ejection fraction (HFpEF)Chronic kidney disease (to reduce progression)Type 1 diabetes (some markets, with insulin)

Dosing

Adult: T2DM: 10 mg OD. HFrEF/HFpEF: 10 mg OD regardless of diabetes status. CKD: 10 mg OD
Pediatric: Not recommended under 18 years in most markets
Renal adjustment: T2DM: start if eGFR >/=25; discontinue if eGFR <15. HF/CKD: continue down to eGFR 15; stop if <15 or dialysis
Hepatic adjustment: No dose adjustment for mild, moderate, or severe hepatic impairment (FDA §8.7); in severe, individually assess benefit–risk.
Geriatric: Standard dosing; monitor for volume depletion and hypotension
Max dose: 10 mg/day

Pharmacokinetics

Onset

Days (glucose lowering); Weeks to months (cardiac/renal benefits)

Peak effect

1-2 hours (Tmax)

Duration

24 hours

Half-life

12.9 hours

Bioavailability

78%

Protein binding

91%

Metabolism

Hepatic UGT1A9-mediated glucuronidation (primary); CYP-mediated metabolism (minor)

Excretion

Urine (75%, primarily as metabolites); fecal (21%)

Contraindications

History of serious hypersensitivity to dapagliflozin
Severe renal impairment (eGFR <15 or dialysis) for glycemic control; eGFR <25 for HF/CKD indications
Diabetic ketoacidosis
Volume depletion

Side effects

Common

Genital mycotic infections (vulvovaginal candidiasis, balanitis)Urinary tract infectionsPolyuriaPollakiuriaVolume depletion symptoms (dizziness, orthostatic hypotension)ThirstConstipationBack pain

Serious