Forxiga (dapagliflozin) is a prescription medication belonging to the sodium-glucose cotransporter 2 (SGLT2) inhibitor class, designed to manage type 2 diabetes mellitus in adults. It works by blocking the reabsorption of glucose in the kidneys, promoting its excretion through urine, thereby lowering blood sugar levels. Beyond glycemic control, Forxiga has demonstrated significant cardiovascular and renal benefits, reducing the risk of hospitalization for heart failure and slowing the progression of kidney disease in indicated patients. It is used both as monotherapy and in combination with other antidiabetic agents, following a comprehensive assessment of the patient’s clinical profile. Adherence to prescribed dosing and regular monitoring are essential to maximize therapeutic outcomes and minimize risks.

Features

• Active ingredient: Dapagliflozin (5 mg or 10 mg film-coated tablets)
• Pharmacologic class: Sodium-glucose cotransporter 2 (SGLT2) inhibitor
• Mechanism: Selective inhibition of SGLT2 in the proximal renal tubules, reducing renal glucose reabsorption
• Administration: Oral, once daily, with or without food
• Packaging: Blister packs of 14, 28, or 56 tablets
• Special storage: Store below 30°C (86°F); keep in original container to protect from moisture

Benefits

• Effective reduction of HbA1c levels, supporting long-term glycemic targets
• Promotes weight loss through caloric excretion via glycosuria
• Lowers systolic and diastolic blood pressure, contributing to cardiovascular risk reduction
• Demonstrates cardioprotective effects, decreasing the risk of heart failure hospitalization
• Shows nephroprotective properties, delaying the progression of renal impairment
• Does not typically cause hypoglycemia when used as monotherapy

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 risk factors. Additionally, it is used to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease.

Dosage and direction

The recommended starting dose is 5 mg or 10 mg orally once daily, taken with or without food. Dosage may be adjusted based on renal function: for patients with eGFR ≥45 mL/min/1.73 m², no adjustment is needed; use is not recommended when eGFR is persistently below 25 mL/min/1.73 m². Tablets should be swallowed whole with water; they should not be split, crushed, or chewed. Regular monitoring of renal function, blood glucose, and volume status is advised.

Precautions

• Monitor for signs and symptoms of volume depletion, particularly in elderly patients, those on diuretics, or with renal impairment.
• Assess renal function before initiation and periodically thereafter.
• Observe for genital mycotic infections; appropriate hygiene is recommended.
• Evaluate for ketoacidosis in the presence of suggestive symptoms, even if blood glucose is not significantly elevated.
• Not recommended during the second and third trimesters of pregnancy.
• Use with caution in patients with history of urinary tract infections or hypotension.

Contraindications

• History of serious hypersensitivity to dapagliflozin or any excipients.
• Severe renal impairment (eGFR <25 mL/min/1.73 m²), end-stage renal disease, or patients on dialysis.
• Type 1 diabetes mellitus or diabetic ketoacidosis.

Possible side effects

Common adverse reactions (≥5%) include:

• Genital mycotic infections
• Urinary tract infections
• Increased urination
• Back pain
• Nausea

Serious but rare side effects may include:

• Ketoacidosis
• Volume depletion
• Acute kidney injury
• Necrotizing fasciitis of the perineum (Fournier’s gangrene)
• Hypersensitivity reactions

Drug interaction

• Concomitant use with insulin or insulin secretagogues may increase the risk of hypoglycemia; dose adjustment of these agents may be required.
• Diuretics may enhance the risk of volume depletion.
• Drugs that reduce renal function may affect glucose-lowering efficacy.
• No clinically significant interactions with metformin, sitagliptin, or warfarin have been observed.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time of the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.

Overdose

In the event of overdose, symptomatic and supportive measures are recommended. Dapagliflozin can be removed by hemodialysis (up to 30% removal over 4 hours). Monitor hydration status, electrolytes, and blood glucose, and manage any clinical consequences accordingly.

Storage

Store in the original package below 30°C (86°F). Keep the container tightly closed to protect from moisture. Do not use if the blister is damaged or tablets show signs of deterioration. Keep out of reach of children.

Disclaimer

This information is intended for healthcare professionals and educated patients and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations based on individual health status and current clinical guidelines.

Reviews

“Forxiga has been a game-changer in my practice, especially for patients with type 2 diabetes and comorbid heart failure. The dual benefits of glycemic control and cardiovascular risk reduction make it a cornerstone therapy.” – Endocrinologist, UK

“Patients appreciate the once-daily dosing and the fact that it doesn’t typically cause hypoglycemia. Weight loss is an added benefit that improves adherence and satisfaction.” – Diabetes Educator, US

“While effective, clinicians must remain vigilant for genital infections and volume-related adverse events, particularly in vulnerable populations.” – Nephrologist, EU