Home Drug Guide Dapagliflozin

Drug Guide

Generic Name

Dapagliflozin

Brand Names Farxiga

Classification

Therapeutic: Antidiabetic agent

Pharmacological: SGLT2 inhibitor

FDA Approved Indications

Type 2 diabetes mellitus

Mechanism of Action

Dapagliflozin inhibits the sodium-glucose co-transporter 2 (SGLT2) in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion, thereby lowering blood glucose levels.

Dosage and Administration

Adult: Start with 5 mg once daily, with or without food. Can be increased to 10 mg based on effectiveness and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution in elderly; consider renal function.

Renal Impairment: Use is contraindicated if eGFR is below 45 mL/min/1.73 m²; dose adjustment recommended.

Hepatic Impairment: No specific adjustment, but use cautiously.

Pharmacokinetics

Absorption: Rapidly absorbed, peak plasma levels in 2 hours.

Distribution: Widely distributed; protein binding approximately 91%.

Metabolism: Minimal metabolism; primarily excreted unchanged.

Excretion: Excreted mainly via urine and feces.

Half Life: Approximately 13 hours.

Contraindications

Severe renal impairment (eGFR below 30 mL/min/1.73 m²)
End-stage renal disease
Ketoacidosis

Precautions

Risk of urinary tract infections, genital mycotic infections, dehydration, hypotension, hyperkalemia, and acute kidney injury.

Adverse Reactions - Common

Genital fungal infections (Frequent)
Urinary tract infections (Frequent)
Hypotension (Infrequent)

Adverse Reactions - Serious

Ketoacidosis (including euglycemic ketoacidosis) (Rare)
Acute kidney injury (Infrequent)
Serious urinary tract infections leading to sepsis (Rare)

Drug-Drug Interactions

Diuretics, insulin, and insulin secretagogues (may increase risk of hypoglycemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose, renal function, blood pressure, and signs of dehydration.

Diagnoses:

Risk for hypoglycemia
Risk for dehydration or electrolyte imbalance

Implementation: Administer as prescribed; ensure patient remains hydrated; monitor renal function.

Evaluation: Assess glycemic control and renal function periodically.

Patient/Family Teaching

Take medication as directed, even if feeling well.
Report signs of urinary tract infections or genital infections.
Maintain adequate hydration.
Understand the importance of regular blood glucose monitoring.

Special Considerations

Black Box Warnings:

There is a risk of diabetic ketoacidosis, which can be life-threatening.
Risk of acute kidney injury.

Genetic Factors: None specified.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe dehydration, hypotension, electrolyte abnormalities, ketoacidosis.

Treatment: Discontinue medication; provide supportive care including rehydration, electrolytes correction, and monitoring.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C).

Stability: Stable for 24 months when stored properly.