Forxiga

Forxiga (dapagliflozin) is a once-daily, prescription-only sodium-glucose cotransporter 2 (SGLT2) inhibitor designed to improve glycemic control in adults with type 2 diabetes. By selectively inhibiting SGLT2 in the proximal renal tubules, it reduces renal glucose reabsorption and increases urinary glucose excretion. This mechanism offers a insulin-independent approach to lowering blood glucose levels, with additional benefits for cardiovascular and renal health in indicated patient populations. It is used both as monotherapy and in combination with other glucose-lowering agents, including insulin, when diet and exercise alone do not provide adequate glycemic control.

Features

• Contains dapagliflozin as the active pharmaceutical ingredient
• Available in 5 mg and 10 mg film-coated tablets
• Oral administration, once daily, with or without food
• Not indicated for type 1 diabetes mellitus or diabetic ketoacidosis
• Manufactured under strict pharmaceutical quality standards

Benefits

• Effectively lowers HbA1c by promoting glucosuria, independent of insulin secretion
• Demonstrates cardiovascular risk reduction in patients with established cardiovascular disease
• Shows renal protective effects, slowing the progression of renal impairment
• Contributes to modest weight loss and blood pressure reduction
• Provides a complementary mechanism of action to other antidiabetic therapies
• Convenient once-daily dosing supports long-term adherence

Common use

Forxiga is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is also approved to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors. Additionally, it is indicated for the treatment of chronic kidney disease in adults with and without type 2 diabetes.

Dosage and direction

The recommended starting dose is 5 mg or 10 mg orally once daily. Dose can be taken with or without food, preferably in the morning. For patients requiring additional glycemic control, the dose may be increased to 10 mg once daily. Renal function should be assessed before initiation and periodically during treatment. Not recommended when eGFR is persistently below 25 mL/min/1.73 m² for diabetes indication or below 25 mL/min/1.73 m² for CKD indication.

Precautions

Monitor renal function before initiation and periodically during treatment. Assess volume status and correct volume depletion before starting. Consider more frequent monitoring in elderly patients, those with renal impairment, and those on diuretics. Monitor for signs and symptoms of genital mycotic infections and urinary tract infections. Regularly monitor blood glucose levels. Not recommended during the second and third trimesters of pregnancy. Discontinue at least 3 days before scheduled surgery.

Contraindications

Hypersensitivity to dapagliflozin or any excipients. Severe renal impairment (eGFR below 25 mL/min/1.73 m²) for diabetes indication. End-stage renal disease or patients on dialysis. History of serious hypersensitivity reactions to SGLT2 inhibitors. Diabetic ketoacidosis.

Possible side effects

Common (≥1/100 to <1/10): Genital mycotic infections, urinary tract infections, increased urination, thirst, constipation, nausea, back pain. Uncommon (≥1/1,000 to <1/100): Hypoglycemia (when used with insulin or sulfonylureas), volume depletion, dyslipidemia, elevated hematocrit. Rare (<1/1,000): Diabetic ketoacidosis, necrotizing fasciitis of the perineum (Fournier’s gangrene), hypersensitivity reactions, renal impairment.

Drug interaction

Increased risk of hypoglycemia when used with insulin or insulin secretagogues. Diuretics may enhance the potential for volume depletion. May interfere with 1,5-anhydroglucitol (1,5-AG) assay, not recommended for monitoring glycemic control. No clinically significant interactions with metformin, pioglitazone, sitagliptin, glimepiride, or warfarin.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If remembered the next day, skip the missed dose and take the next scheduled dose. Do not take a double dose to make up for a missed dose.

Overdose

In case of overdose, contact poison control or seek immediate medical attention. Symptoms may include severe hypoglycemia, dehydration, and electrolyte abnormalities. Treatment should be symptomatic and supportive. Hemodialysis is unlikely to be effective due to high protein binding.

Storage

Store below 30°C (86°F). Keep in the original package to protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider before starting or changing any medication regimen. Individual results may vary. Proper diagnosis and treatment should be determined by a healthcare professional familiar with the patient’s complete medical history.

Reviews

Clinical trials demonstrate Forxiga’s efficacy in glycemic control with mean HbA1c reductions of 0.5-0.8% from baseline. The DECLARE-TIMI 58 trial showed a 17% reduction in cardiovascular death or hospitalization for heart failure in patients with type 2 diabetes and established cardiovascular disease. The DAPA-CKD trial demonstrated a 39% reduction in risk of worsening renal function or cardiovascular or renal death in patients with chronic kidney disease. Real-world evidence supports the cardiovascular and renal benefits observed in clinical trials.