What is Dapagliflozin: Uses, Dosage, Side Effects and More

Dapagliflozin is a prescription medication that helps manage blood sugar levels in people with type 2 diabetes. This medication belongs to a class of drugs called SGLT2 inhibitors, which work by helping your kidneys remove excess glucose from your body through urine. Beyond diabetes management, doctors also prescribe dapagliflozin to treat heart failure and chronic kidney disease in certain patients.

What is Dapagliflozin?

Dapagliflozin is an oral medication that blocks a specific protein in your kidneys called SGLT2 (sodium-glucose cotransporter 2). This protein normally helps your kidneys reabsorb glucose back into your bloodstream. When dapagliflozin blocks this protein, your kidneys flush out more glucose through your urine instead of keeping it in your blood.

You might recognize this medication by its brand name, Farxiga. The drug was first approved by the FDA in 2014 and has since become a valuable tool in managing several conditions. It comes as a tablet that you take by mouth once daily, making it convenient for most people to incorporate into their daily routine.

What is Dapagliflozin Used For?

Dapagliflozin serves three main purposes in modern medicine. First and most commonly, it helps adults with type 2 diabetes control their blood sugar levels when diet and exercise alone aren't enough. Many doctors prescribe it alongside other diabetes medications like metformin to provide better blood sugar control.

Second, this medication can help adults with heart failure, particularly those with reduced ejection fraction. Your heart's ejection fraction measures how well your heart pumps blood with each beat. When this function is impaired, dapagliflozin can help reduce the risk of hospitalization and cardiovascular death.

Third, doctors may prescribe dapagliflozin for adults with chronic kidney disease to slow the progression of kidney damage. This use is particularly important because kidney disease often develops alongside diabetes and heart conditions. The medication helps protect your kidneys from further damage while supporting your overall health.

How Does Dapagliflozin Work?

Dapagliflozin works differently from many other diabetes medications. Instead of forcing your pancreas to produce more insulin or making your cells more sensitive to insulin, it takes a unique approach through your kidneys. Think of your kidneys as sophisticated filters that normally save glucose and return it to your bloodstream.

When you take dapagliflozin, it blocks the SGLT2 proteins in your kidneys that would normally reclaim glucose. This means more glucose gets filtered out of your blood and eliminated through your urine. As a result, your blood sugar levels naturally decrease without putting extra strain on your pancreas.

This medication is considered moderately effective for blood sugar control. While it may not lower your A1C (a measure of average blood sugar over 2-3 months) as dramatically as insulin or some other medications, it offers unique benefits. Many people experience modest weight loss and blood pressure reduction as welcome side effects of the increased glucose elimination.

How Should I Take Dapagliflozin?

Take dapagliflozin exactly as your doctor prescribes, typically once daily in the morning. You can take it with or without food, which makes it flexible for your daily routine. Swallow the tablet whole with a glass of water rather than crushing, chewing, or breaking it.

Taking this medication in the morning is generally recommended because it increases urination throughout the day. This timing helps you avoid frequent nighttime bathroom trips that might disrupt your sleep. If you're starting this medication, you might notice increased urination within the first few days as your body adjusts.

Stay well-hydrated while taking dapagliflozin, especially during hot weather or when you're exercising. The medication causes you to lose more fluid through increased urination, so drinking plenty of water helps prevent dehydration. Aim for at least 8 glasses of water daily unless your doctor advises otherwise.

If you have kidney problems, your doctor will likely start you on a lower dose and monitor your kidney function regularly. They may also adjust your dose based on how well your kidneys are working and how you respond to the medication.

How Long Should I Take Dapagliflozin For?

Dapagliflozin is typically a long-term medication that you'll continue taking as long as it's helping your condition and you're tolerating it well. For type 2 diabetes, this often means taking it indefinitely since diabetes is a chronic condition that requires ongoing management.

Your doctor will monitor your progress through regular blood tests and check-ups to ensure the medication continues working effectively. They'll look at your blood sugar levels, kidney function, and overall health to determine if you should continue taking dapagliflozin. Some people may need dose adjustments over time based on how their body responds.

If you're taking dapagliflozin for heart failure or chronic kidney disease, the duration of treatment depends on your specific condition and how well you're responding. Your doctor will work with you to create a treatment plan that addresses your individual needs and health goals.

Never stop taking dapagliflozin suddenly without talking to your doctor first. Stopping abruptly could cause your blood sugar levels to rise quickly, which might be dangerous. If you need to discontinue the medication, your doctor will help you do so safely and may suggest alternative treatments.

What Are the Side Effects of Dapagliflozin?

Like all medications, dapagliflozin can cause side effects, though not everyone experiences them. Understanding what to expect can help you feel more prepared and know when to contact your healthcare provider.

The most common side effects are generally mild and often improve as your body adjusts to the medication:

• Increased urination and thirst (very common in the first few weeks)
• Urinary tract infections, especially in women
• Yeast infections in the genital area
• Dizziness or lightheadedness when standing up
• Nausea or upset stomach
• Back pain
• Constipation

These common side effects usually become less noticeable as your body adapts to the medication. The increased urination, for example, often becomes less bothersome after the first few weeks of treatment.

More serious side effects are less common but require immediate medical attention. These include signs of dehydration like extreme thirst, dry mouth, or dizziness that doesn't improve with rest. You should also watch for symptoms of ketoacidosis, a potentially dangerous condition that can occur even with normal blood sugar levels.

Rare but serious side effects that need immediate medical care include:

• Severe dehydration with symptoms like confusion, rapid heartbeat, or fainting
• Diabetic ketoacidosis (fruity breath odor, nausea, vomiting, abdominal pain)
• Serious urinary tract infections that spread to the kidneys
• Necrotizing fasciitis (severe infection of the tissue under the skin around the genitals)
• Severe allergic reactions with difficulty breathing or swelling of face and throat

If you experience any of these serious symptoms, seek medical attention immediately. While these complications are rare, being aware of them helps ensure you get prompt treatment if needed.

Who Should Not Take Dapagliflozin?

Dapagliflozin isn't suitable for everyone, and your doctor will carefully consider your medical history before prescribing it. People with type 1 diabetes should not take this medication because it can increase their risk of developing dangerous ketoacidosis.

If you have severe kidney disease, your doctor will likely avoid prescribing dapagliflozin or use it with extreme caution. The medication works through your kidneys, so reduced kidney function can affect both its effectiveness and safety. Your doctor will check your kidney function with blood tests before starting treatment.

Other conditions that may prevent you from taking dapagliflozin include:

• Severe liver disease
• History of diabetic ketoacidosis
• Severe heart failure requiring hospitalization
• Active bladder cancer or history of bladder cancer
• Pregnancy or breastfeeding
• Severe dehydration or electrolyte imbalances

Older adults may need special consideration when taking dapagliflozin. Age-related changes in kidney function and increased risk of dehydration mean your doctor will monitor you more closely and possibly start with a lower dose.

Tell your doctor about all medications you're taking, including over-the-counter drugs and supplements. Certain medications, particularly those that affect blood pressure or blood sugar, may interact with dapagliflozin and require dose adjustments.

Dapagliflozin Brand Names

Dapagliflozin is most commonly known by its brand name Farxiga, which is manufactured by AstraZeneca. This is the name you'll likely see on your prescription bottle and medication packaging. Farxiga is available in several strengths, typically 5mg and 10mg tablets.

In some countries, you might encounter dapagliflozin under different brand names, though Farxiga remains the most widely recognized globally. Your pharmacist can help you identify the correct medication regardless of the brand name, as they'll verify the active ingredient is dapagliflozin.

Some combination medications contain dapagliflozin along with other diabetes drugs. For example, Xigduo XR combines dapagliflozin with metformin, while Qtern combines it with saxagliptin. These combination pills can be convenient if you're taking multiple diabetes medications.

Dapagliflozin Alternatives

If dapagliflozin isn't right for you, several alternatives can help manage your condition. Other SGLT2 inhibitors work similarly to dapagliflozin and include empagliflozin (Jardiance) and canagliflozin (Invokana). These medications have similar benefits and side effects, though individual responses can vary.

For type 2 diabetes management, alternatives include different classes of medications with various mechanisms of action. Metformin remains the first-line treatment for most people with type 2 diabetes. GLP-1 receptor agonists like semaglutide (Ozempic) or liraglutide (Victoza) offer excellent blood sugar control with potential weight loss benefits.

Other options include:

• DPP-4 inhibitors like sitagliptin (Januvia) for mild blood sugar elevation
• Sulfonylureas like glyburide or glipizide for more significant blood sugar reduction
• Insulin therapy for more advanced diabetes or when other medications aren't sufficient
• Thiazolidinediones like pioglitazone for insulin resistance

Your doctor will consider your specific health needs, other medical conditions, and treatment goals when selecting the best alternative. The choice depends on factors like how well your pancreas is functioning, your kidney health, and your risk of side effects.

Is Dapagliflozin Better Than Metformin?

Dapagliflozin and metformin work differently and serve different roles in diabetes management. Metformin is typically the first medication doctors prescribe for type 2 diabetes because it's been used safely for decades and has extensive research supporting its effectiveness.

Metformin primarily works by reducing glucose production in your liver and improving insulin sensitivity in your muscles and other tissues. It's generally well-tolerated, inexpensive, and has proven cardiovascular benefits. Most people with type 2 diabetes will start with metformin before considering other medications.

Dapagliflozin offers unique advantages that metformin doesn't provide. It can promote modest weight loss, reduce blood pressure, and provide cardiovascular and kidney protection benefits. The medication also works independently of insulin, making it effective even when your pancreas isn't producing much insulin.

Rather than being better or worse than metformin, dapagliflozin is often used alongside metformin for enhanced blood sugar control. Many people take both medications together, as they work through different mechanisms and complement each other well. Your doctor might add dapagliflozin if metformin alone isn't achieving your blood sugar targets.