What is Dapagliflozin – and Who Should Benefit From It?

What is dapagliflozin – and who should benefit from it?

Type of drug

Dapagliflozin (Forxiga®) is a sodium-glucose cotransporter 2 (SGLT-2) inhibitor

How it works

It works by blocking reabsorption of glucose in the PCT of the kidney leading to more glucose loss in the urine

Who should benefit from it?

People with:

• Type 2 diabetes
• Proteinuric CKD (i.e. with protein in urine)
• Chronic heart failure (CHF)

Dose

10 mg once a day (including CKD patients), i.e. dosing is simple

Side-effects

• Initial decrease (<10%) in GFR (increases later); low blood glucose (sugar)
• UTIs; vulvovaginal disorders; DKA

Monitoring

Creatinine/GFR; glucose, HbA1c

Notes

• Its anti-proteinuric effect is augmented if the patient is also on an ACE or ARB
• Do not use in DM1
• Indicated in proteinuric CKD (uACR >25 mg/mmol) with GFR <60 and >25 ml/min (with or without DM)
• But do not initiate in Stage 5 CKD (GFR < 15 ml/min)
• Do not measure U+E within 4 weeks – as there may be a small (reversible) increase in creatinine/fall in GFR.

How does dapagliflozin work in chronic kidney disease (CKD)?

Reducing protein loss reduces kidney damage by reducing pressure and inflammation in the kidneys.

It also reduces blood pressure and body weight (by increasing loss of sodium and water), which helps the kidneys.

Other Resources

CKD drug side-effects
CKD referral advice (GP Gateway)
Dapagliflozin (BNF)

This is a review article: Young, 2023