Dapagliflozin

SGLT2 Inhibitor·Endocrinology - Oral Antidiabetics

Type 2 Diabetes, Heart Failure (all ejection fractions), Chronic Kidney Disease

Authority requiredPBSORALForxiga, Xigduo (combo with metformin)10 mg tablet+2

Max Dose

10 mg/day

Half-life

13 h

Euglycemic DKA

CRITICAL

Heart Failure

INDICATED

Rapid Summary

Overview

SGLT2 inhibitor. Forces the kidneys to pee out glucose. Provides massive, independent mortality benefits in Heart Failure (HFrEF and HFpEF) and Chronic Kidney Disease.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Carries a lethal risk of Euglycemic Diabetic Ketoacidosis (DKA with a normal blood sugar). Must be ceased during acute illness or surgery.

Bottom Line

Dapagliflozin is an SGLT2 inhibitor with proven heart failure and CKD benefits independent of diabetes, but carries the same class risks of euglycaemic DKA and genital infections.

Formulation & Access

Brand Names

Forxiga, Xigduo (combo with metformin)

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Type 2 Diabetes, Heart Failure (all ejection fractions), Chronic Kidney Disease.

Clinical Place

Standard of care for cardiac and renal protection. Often prescribed by cardiologists/nephrologists rather than just endocrinologists.

Quick reference

Class & Role

SGLT2 Inhibitor — SGLT2 inhibitor.

Route / Formulation

Tablets (10 mg). (Forxiga, Xigduo (combo with metformin))

Usual Dose & Max

PO 10 mg OD. Max 10 mg/day.

Key Indication Doses

Type 2 Diabetes / Heart Failure / CKD: PO 10 mg OD. Renal Impairment: For diabetes control, initiate only if eGFR > 45. For Heart Failure/CKD protection, can be initiated down to an eGFR of 25.

Best Uses

Dapagliflozin is an SGLT2 inhibitor with proven heart failure and CKD benefits independent of diabetes, but carries the same class risks of euglycaemic DKA and genital infections.

Avoid / Cautions

Type 1 Diabetes (DKA risk is too high). Pregnancy Category D.

Key Risks

Metabolic: Euglycemic DKA. The patient starves at a cellular level, generating ketones, but the BSL looks normal because the kidneys are hiding the sugar in the urine. Genitourinary: Genital mycotic infections (thrush), UTIs. CRITICAL — Fournier's gangrene (rare necrotising fasciitis of the perineum). Cardiovascular: Hypovolemia, orthostatic hypotension (due to osmotic diuresis).

Key Interactions

Additive hypotension and dehydration if combined with Loop or Thiazide diuretics.

Monitoring

'Sick Day Rules': Cease immediately if the patient is vomiting, fasting, or has a severe infection. Check blood KETONES (not just BSL) if unwell. Monitor U&E and eGFR.

Clinical Pearl

If a patient on Forxiga feels nauseous and breathless in the ED, and their BSL is a perfect 6.0 mmol/L, do NOT send them home. You MUST check blood ketones or an ABG. If ketones are high, they are in DKA and need IV insulin and dextrose instantly.

Access

Authority requiredForxiga, Xigduo (combo with metformin)10 mg tablet

Brand: Forxiga, Xigduo (combo with metformin)
PBS status: Authority required
Formulation: Tablets (10 mg)

Dapagliflozin

SGLT2 Inhibitor·Endocrinology - Oral Antidiabetics

Type 2 Diabetes, Heart Failure (all ejection fractions), Chronic Kidney Disease

Authority requiredPBSORALForxiga, Xigduo (combo with metformin)10 mg tablet+2

Max Dose

10 mg/day

Half-life

13 h

Euglycemic DKA

CRITICAL

Heart Failure

INDICATED

Rapid Summary

Overview

SGLT2 inhibitor. Forces the kidneys to pee out glucose. Provides massive, independent mortality benefits in Heart Failure (HFrEF and HFpEF) and Chronic Kidney Disease.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Carries a lethal risk of Euglycemic Diabetic Ketoacidosis (DKA with a normal blood sugar). Must be ceased during acute illness or surgery.

Bottom Line

Dapagliflozin is an SGLT2 inhibitor with proven heart failure and CKD benefits independent of diabetes, but carries the same class risks of euglycaemic DKA and genital infections.

Formulation & Access

Brand Names

Forxiga, Xigduo (combo with metformin)

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Type 2 Diabetes, Heart Failure (all ejection fractions), Chronic Kidney Disease.

Clinical Place

Standard of care for cardiac and renal protection. Often prescribed by cardiologists/nephrologists rather than just endocrinologists.

Quick reference

Class & Role

SGLT2 Inhibitor — SGLT2 inhibitor.

Route / Formulation

Tablets (10 mg). (Forxiga, Xigduo (combo with metformin))

Usual Dose & Max

PO 10 mg OD. Max 10 mg/day.

Key Indication Doses

Type 2 Diabetes / Heart Failure / CKD: PO 10 mg OD. Renal Impairment: For diabetes control, initiate only if eGFR > 45. For Heart Failure/CKD protection, can be initiated down to an eGFR of 25.

Best Uses

Dapagliflozin is an SGLT2 inhibitor with proven heart failure and CKD benefits independent of diabetes, but carries the same class risks of euglycaemic DKA and genital infections.

Avoid / Cautions

Type 1 Diabetes (DKA risk is too high). Pregnancy Category D.

Key Risks

Key Interactions

Additive hypotension and dehydration if combined with Loop or Thiazide diuretics.

Monitoring

'Sick Day Rules': Cease immediately if the patient is vomiting, fasting, or has a severe infection. Check blood KETONES (not just BSL) if unwell. Monitor U&E and eGFR.

Clinical Pearl

Access

Authority requiredForxiga, Xigduo (combo with metformin)10 mg tablet

Brand: Forxiga, Xigduo (combo with metformin)
PBS status: Authority required
Formulation: Tablets (10 mg)