From the Guidelines
You should temporarily stop taking dapagliflozin when experiencing vomiting, as recommended by the most recent consensus guidelines 1. This medication belongs to a class called SGLT2 inhibitors and should be paused during episodes of vomiting, diarrhea, or any illness that reduces your food and fluid intake. This is known as the "sick day rule" for SGLT2 inhibitors. When you're vomiting, you're at increased risk of dehydration and developing a dangerous condition called euglycemic diabetic ketoacidosis (eDKA). Dapagliflozin works by causing your kidneys to remove sugar through urine, which can worsen dehydration when you're already losing fluids through vomiting. You should contact your healthcare provider about when to safely restart the medication, which is typically when you can eat and drink normally again for 24-48 hours. While pausing dapagliflozin, continue monitoring your blood glucose levels more frequently and stay hydrated if possible. Remember to resume the medication once you've recovered and your doctor confirms it's safe to do so.
Some key points to consider when stopping dapagliflozin due to vomiting include:
- Monitoring for signs of dehydration and eDKA, such as excessive thirst, dark urine, and abdominal pain 1
- Maintaining at least low-dose insulin if you're insulin-requiring, to mitigate the risk of ketoacidosis 1
- Considering proactive dose reduction of diuretics if you're at high risk of volume depletion 1
- Resuming the medication only when you can eat and drink normally again for 24-48 hours, and after consulting with your healthcare provider 1
It's essential to follow the "sick day rule" for SGLT2 inhibitors, as recommended by the consensus guidelines 1, to minimize the risk of complications and ensure your safety while taking dapagliflozin.
From the FDA Drug Label
If symptoms of ketoacidosis occur, instruct patients to discontinue DAPAGLIFLOZIN TABLETS and seek medical attention immediately [see Warnings and Precautions (5. 1)]. Educate all patients on precipitating factors (such as insulin dose reduction or missed insulin doses, infection, reduced caloric intake, ketogenic diet, surgery, dehydration, and alcohol abuse) and symptoms of ketoacidosis (including nausea, vomiting, abdominal pain, tiredness, and labored breathing)
Vomiting is a symptom of ketoacidosis.
- The patient should stop taking dapagliflozin if they experience symptoms of ketoacidosis, including vomiting, and seek medical attention immediately 2.
From the Research
Dapagliflozin and Vomiting
- Dapagliflozin is a SGLT2 inhibitor used to treat diabetes, and its effect on fluid and electrolyte balance has been studied 3.
- In diabetic rats, dapagliflozin treatment decreased blood glucose concentration and increased urinary glucose excretion, but did not result in significant electrolyte disorders or volume depletion 3.
- However, dapagliflozin may induce changes in electrolyte balances, including increases in serum phosphate, FGF-23, and PTH, and reductions in 1,25-dihydroxyvitamin D 4.
Electrolyte Disorders and Vomiting
- Vomiting can be a symptom of electrolyte disorders, such as hyponatremia and hypernatremia 5, 6.
- The management of electrolyte disorders involves measuring serum electrolytes, serum glucose, serum and urine osmolarity, and sodium in urine, as well as estimating the volume status of the patient 6.
- In cases of vomiting, it is essential to consider the time between initial ingestion of medication and vomiting, as well as the type of medication and patient status, when deciding whether to redose 7.
Redosing Dapagliflozin After Vomiting
- There is no specific guidance on redosing dapagliflozin after vomiting, but the general principles of managing electrolyte disorders and redosing medications after vomiting may apply 5, 6, 7.
- Healthcare professionals should consider the individual patient's circumstances, including the severity of vomiting, the time between initial ingestion and vomiting, and the patient's overall health status, when deciding whether to redose dapagliflozin 7.