Dapagliflozin
FARXIGA
Pronunciation: dap-a-gli-FLOE-zin
“Foxy Dapper”
SGLT2 inhibitor theme
What it isSGLT2 inhibitor causing urinary glucose and sodium loss; type 2 diabetes, heart failure and chronic kidney disease.
Why this oneIt was the first SGLT2 inhibitor to gain a heart-failure indication without requiring type 2 diabetes.
What limits itGenital mycotic infection and volume depletion. Hold during acute illness and before surgery because of euglycemic ketoacidosis.
FDA-approved for
- type 2 diabetes (2014)
- heart failure (2020)
- chronic kidney disease (2021)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 2 diabetes mellitus, glycemic control | Adults (eGFR ≥45) | 5 mg QD | 5–10 mg QD | 10 mg QD |
| Chronic kidney disease at risk of progression (reduce eGFR decline, ESKD, CV death, hHF) | Adults (initiate if eGFR ≥25) | 10 mg QD | 10 mg QD | 10 mg QD |
| Heart failure (reduce CV death, hHF, urgent HF visit) | Adults (initiate if eGFR ≥25) | 10 mg QD | 10 mg QD | 10 mg QD |
| Reduce hHF risk in T2DM with established CV disease or multiple CV risk factors | Adults (initiate if eGFR ≥25) | 10 mg QD | 10 mg QD | 10 mg QD |
| Type 2 diabetes mellitus, glycemic control | Pediatric ≥10 y (eGFR ≥45) | 5 mg QD | 5–10 mg QD | 10 mg QD |
Renal Glycemic control: usual dose if eGFR ≥45; not recommended if eGFR <45 (likely ineffective). Other indications: usual dose if eGFR ≥25; do not initiate if eGFR <25; may continue 10 mg QD if eGFR falls below 25.
Hepatic No adjustment (mild, moderate, or severe); assess benefit-risk individually in severe impairment
Not for glycemic control in type 1 diabetes; not for CKD due to polycystic kidney disease or with recent immunosuppressive therapy for kidney disease.
Instructions
- Take orally once daily
- Assess renal function and correct volume depletion before initiating
- Withhold at least 3 days before surgery or procedures with prolonged fasting; resume when clinically stable and eating
- Missed dose: take as soon as possible; do not double up
Available strengths
- tab 5, 10 mg
Cautions
- Diabetic ketoacidosis in T1DM and other ketoacidosis
- Volume depletion
- Genitourinary infections incl. urosepsis, pyelonephritis, Fournier's gangrene, genital mycotic infections
- Hypoglycemia with insulin or insulin secretagogues
Adverse reactions
- Female genital mycotic infections
- Nasopharyngitis
- Urinary tract infections
- Back pain
- Increased urination
- Male genital mycotic infections
- Nausea
- Influenza
- Dyslipidemia
- Constipation
- Discomfort with urination
- Pain in extremity
Pregnancy Not recommended in 2nd and 3rd trimesters (adverse renal effects in animals); limited human data.
Lactation Not recommended while breastfeeding (potential risk to developing infant kidney).
Cost
Generic entry2026
NO BOXED WARNINGS
Principal riskEuglycemic diabetic ketoacidosis
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.
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