Dapagliflozin

FARXIGA

What it isSGLT2 inhibitor causing urinary glucose and sodium loss; type 2 diabetes, heart failure and chronic kidney disease.

Why this oneIt was the first SGLT2 inhibitor to gain a heart-failure indication without requiring type 2 diabetes.

What limits itGenital mycotic infection and volume depletion. Hold during acute illness and before surgery because of euglycemic ketoacidosis.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Type 2 diabetes mellitus, glycemic control	Adults (eGFR >=45)	5 mg QD	10 mg QD	10 mg QD
Reduce risk of hospitalization for heart failure (T2DM with CVD or multiple CV risk factors)	Adults (eGFR >=25)	10 mg QD	10 mg QD	10 mg QD

Renal Glycemic control: not recommended if eGFR <45 (likely ineffective). Non-glycemic indication: use down to eGFR 25.

Hepatic No adjustment for mild, moderate, or severe; assess benefit-risk individually in severe.

Diabetic ketoacidosis (including in T2DM/T1DM); assess ketones and discontinue if suspected
Volume depletion/hypotension, esp. elderly, renal impairment, on diuretics
Genitourinary infections including necrotizing fasciitis of perineum (Fournier's gangrene), urosepsis, pyelonephritis, genital mycotic infections
Hypoglycemia when combined with insulin/insulin secretagogues

Pregnancy Not recommended in 2nd and 3rd trimesters (animal renal effects).

Lactation Not recommended while breastfeeding.

NO BOXED WARNINGS

Principal riskEuglycemic diabetic ketoacidosis

Cost, est. cash$300–$1,000/month

Generic entry2026

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent

Defining liabilityAgent-specific hypoglycemia, ketoacidosis, volume, renal or gastrointestinal toxicity.

Box: minimal PK interactions