Dapagliflozin
Dapagliflozin is an SGLT2 inhibitor originally developed for type 2 diabetes but now also recognised for its benefits in heart failure (HFrEF) and chronic kidney disease (CKD), independent of glycaemic control. It reduces hospitalisation for heart failure and slows CKD progression. 💊🫀👉 Always check the BNF for latest prescribing advice.
📌 About
- Licensed in the UK for Type 2 Diabetes, Heart Failure with reduced EF, and CKD.
- Not currently recommended for Type 1 Diabetes due to increased risk of ketoacidosis.
- Prescribing guidance is regularly updated by NICE and BNF.
⚙️ Mode of Action
- Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the proximal tubule.
- ↓ Glucose reabsorption → ↑ urinary glucose excretion (glucosuria).
- Causes osmotic diuresis and natriuresis → ↓ preload & afterload, helping heart failure.
- Renal protective: reduces intraglomerular pressure and slows CKD progression.
💊 Indication & Dose (Typical Adult)
| Indication | Dose | Frequency | Route |
|---|
| Type 2 Diabetes Mellitus | 10 mg | OD | PO |
| Heart Failure (HFrEF) | 10 mg | OD | PO |
| Chronic Kidney Disease | 10 mg | OD | PO |
🔄 Interactions
- Risk of hypotension with diuretics or dehydration.
- Increased hypoglycaemia risk with insulin or sulfonylureas.
⚠️ Cautions
- DKA: Can occur even with normal glucose ("euglycaemic DKA"). Educate patients on sick day rules, perioperative withholding, and when unwell.
- Hypotension/Volume Depletion: Correct hypovolaemia before initiation.
- Infections: Higher risk of genital mycotic infections and UTIs.
- Renal impairment: Check eGFR before starting; dosing restricted in severe CKD.
🚫 Contraindications
- Type 1 diabetes (DKA risk).
- History of DKA on SGLT2 inhibitors.
- Severe renal impairment (check BNF for eGFR cut-offs).
💥 Side Effects
- DKA (including euglycaemic DKA).
- Fournier’s gangrene (rare but life-threatening).
- Genital infections, UTIs.
- Hypoglycaemia (if used with insulin or sulfonylurea).
- Dizziness, back pain, dyslipidaemia.
💡 Clinical Pearl: In patients with diabetes + heart failure or CKD, dapagliflozin is often preferred even if HbA1c is at target, due to its cardio-renal benefits independent of glucose lowering.
📚 References
- BNF: Dapagliflozin
- NICE TA679 (2021) – Dapagliflozin for treating chronic heart failure with reduced ejection fraction
- NICE NG136 – Hypertension in adults: diagnosis and management
- EMPA-REG, DAPA-HF, DAPA-CKD trial data
