Gatifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
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
KDIGO 2024 + manufacturer label
- 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 11 →
- 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
- Diabetic ketoacidosis (euglycemic DKA possible)
- Fournier's gangrene (necrotizing fasciitis of perineum)
- Volume depletion / acute kidney injury
- Severe UTI (pyelonephritis, urosepsis)
- Lower limb amputation (risk signal, causal relationship uncertain)
- Hypersensitivity reactions
Pregnancy & lactation
Pregnancy
Avoid in second and third trimesters; animal studies show renal developmental toxicity; limited data in first trimester
Lactation
Excreted in breast milk; avoid during breastfeeding
Drug interactions
Ace Inhibitors
Moderate
Database
Increased risk of hypotension and potential for acute kidney injury, especially in patients with pre-existing renal impairment or volume depletion.
Monitor blood pressure and renal function closely, especially at initiation of therapy or dose changes. Ensure adequate hydration. Consider dose adjustment of either agent if hypotension or renal dysfunction occurs.
Angiotensin Receptor Blockers (arbs)
Moderate
Database
Increased risk of hypotension and potential for acute kidney injury, especially in patients with pre-existing renal impairment or volume depletion.
Monitor blood pressure and renal function closely, especially at initiation of therapy or dose changes. Ensure adequate hydration. Consider dose adjustment of either agent if hypotension or renal dysfunction occurs.
Furosemide
Moderate
Database
Excessive diuresis, dehydration, hypotension, AKI
Monitor volume status. Reduce furosemide dose.
Source: DDInter
Lithium
Moderate
Database
SGLT2 inhibition reduces renal lithium clearance; can cause lithium toxicity
Monitor lithium levels closely; avoid if possible
Source: Kimi deep-research + Cla
Loop Diuretics
Moderate
Database
Additive volume depletion and hypotension risk; may precipitate AKI
Monitor volume status, renal function, and BP; consider reducing diuretic dose
Source: Kimi deep-research + Cla
Nsaids
Moderate
Database
NSAIDs can impair renal function and, in combination with dapagliflozin's diuretic effect, may increase the risk of acute kidney injury, especially in volume-depleted patients or those with pre-existing renal impairment.
Monitor renal function closely, especially in patients at higher risk. Ensure adequate hydration. Avoid concomitant use in patients with significant renal impairment or volume depletion if possible.
Rifampicin
Moderate
Database
Reduced SGLT2i levels
Monitor glucose. May need dose adjustment.
Source: DDInter
Spironolactone
Moderate
Database
Hypotension, dehydration
Monitor volume status and electrolytes.
Source: DDInter
Sulfonylureas
Moderate
Database
Increased risk of hypoglycemia.
When dapagliflozin is added to sulfonylurea therapy, a lower dose of the sulfonylurea may be required to minimize the risk of hypoglycemia. Monitor blood glucose levels closely and adjust sulfonylurea dose as needed.
Thiazide Diuretics
Moderate
Database
Increased risk of dehydration, hypovolemia, and hypotension, especially in elderly patients or those with impaired renal function.
Monitor for signs and symptoms of dehydration and hypotension. Consider reducing the dose of the thiazide diuretic or dapagliflozin, or temporarily discontinuing dapagliflozin during periods of acute illness or dehydration.
1 additional low-confidence interaction hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Dapagliflozin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19