Forxiga (dapagliflozin) is a groundbreaking sodium-glucose cotransporter 2 (SGLT2) inhibitor designed to manage type 2 diabetes mellitus by promoting urinary glucose excretion. It offers a dual mechanism that not only improves glycemic parameters but also provides significant cardiorenal benefits, making it a cornerstone in modern diabetes management. Clinically proven to reduce HbA1c, body weight, and systolic blood pressure, Forxiga represents an advanced therapeutic option for patients requiring comprehensive metabolic control. Its well-established safety profile and additional indications in heart failure and chronic kidney disease underscore its role as a multifunctional agent in long-term patient care.

Features

• Contains dapagliflozin propanediol monohydrate equivalent to 5 mg or 10 mg dapagliflozin
• Selective and reversible SGLT2 inhibition
• Once-daily oral administration
• Not dependent on insulin secretion for efficacy
• Stable pharmacokinetic profile with minimal food interaction
• Available in film-coated tablet formulation

Benefits

• Significant reduction in HbA1c levels through insulin-independent mechanism
• Demonstrated cardiovascular risk reduction in patients with established cardiovascular disease
• Promotes weight loss through caloric excretion via glycosuria
• Reduces systolic blood pressure through mild diuretic effect
• Shows renal protective effects by reducing albuminuria and slowing kidney function decline
• Low risk of hypoglycemia when used as monotherapy

Common use

Forxiga is primarily indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is also approved for the treatment of heart failure with reduced ejection fraction (HFrEF) in adults and for the management of chronic kidney disease in patients at risk of progression. The medication may be used as monotherapy or in combination with other antidiabetic agents, including metformin, insulin, sulfonylureas, and DPP-4 inhibitors, depending on individual patient needs and treatment goals.

Dosage and direction

The recommended starting dose is 5 mg once daily, taken orally in the morning with or without food. Based on glycemic response and tolerability, the dose may be increased to 10 mg once daily. For heart failure and chronic kidney disease indications, the recommended dose is 10 mg once daily. Tablets should be swallowed whole with a glass of water. Dose adjustments may be necessary in elderly patients or those with renal impairment, particularly when eGFR falls below 60 mL/min/1.73m². Hepatic impairment does not require dose adjustment.

Precautions

Patients should maintain adequate hydration to reduce the risk of volume depletion-related adverse events. Regular monitoring of renal function is recommended, particularly during initiation and dose escalation. Ketoacidosis has been reported in patients with type 1 and type 2 diabetes; patients should be educated about recognizing symptoms. Genital mycotic infections may occur more frequently; appropriate hygiene should be maintained. Limb amputations have been observed; monitor patients for infections, new pain, or sores. Not recommended during the second and third trimesters of pregnancy.

Contraindications

Forxiga is contraindicated in patients with hypersensitivity to dapagliflozin or any excipients. It should not be used for treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Contraindicated in patients with severe renal impairment (eGFR <30 mL/min/1.73m²), end-stage renal disease, or those on dialysis. Avoid use in patients with history of Fournier’s gangrene. Not recommended during lactation.

Possible side effects

Common adverse reactions (≥2%) include genital mycotic infections, urinary tract infections, increased urination, back pain, nausea, and constipation. Less frequently reported effects include volume depletion, dyslipidemia, hypoglycemia (when used with insulin or sulfonylureas), and elevated hematocrit. Serious but rare side effects include ketoacidosis, acute kidney injury, Fournier’s gangrene, and serious urinary tract infections. Allergic reactions including rash, urticaria, and angioedema may occur.

Drug interaction

Diuretics may enhance the risk of volume depletion. Insulin and insulin secretagogues may increase hypoglycemia risk, requiring dose adjustment. Drugs that reduce renal function may diminish efficacy. No clinically significant interactions with metformin, pioglitazone, sitagliptin, glimepiride, or simvastatin. UGT1A9 inducers may decrease dapagliflozin exposure. Monitor patients when co-administering with other SGLT2 inhibitors.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If remembered near the time of the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Do not take a double dose to make up for a missed dose. Patients should be educated to maintain consistent daily dosing for optimal glycemic control.

Overdose

In case of overdose, symptomatic and supportive treatment is recommended. Dapagliflozin is eliminated primarily through renal excretion. Hemodialysis may remove up to 15% of the dose over 4 hours. Monitor for signs and symptoms of dehydration, hypoglycemia, and electrolyte abnormalities. Maintain fluid balance and provide appropriate glucose management if hypoglycemia occurs. Contact poison control center for latest guidance.

Storage

Store at room temperature (20-25°C) with excursions permitted between 15-30°C. Keep in original container to protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Protect from light and excessive humidity. Do not store in bathroom or near kitchen sink.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any treatment regimen. Individual patient responses may vary. The prescribing physician should be familiar with the complete prescribing information and latest clinical guidelines. Not all possible uses, directions, precautions, or side effects are included here.

Reviews

Clinical trials demonstrate Forxiga’s consistent efficacy in HbA1c reduction (0.5-1.0%) with favorable weight loss (2-3 kg) and blood pressure improvements. The DECLARE-TIMI 58 trial showed a 17% reduction in cardiovascular death or hospitalization for heart failure. DAPA-CKD trial demonstrated a 39% reduction in risk of sustained decline in eGFR ≥50%, end-stage kidney disease, or renal or cardiovascular death. Real-world evidence supports the trial findings, with patients reporting improved quality of life measures. Healthcare providers note the convenience of once-daily dosing and the additional cardiorenal benefits beyond glucose control.