What health conditions should be assessed before initiating dapagliflozin (Forxiga) therapy?

From the Guidelines

Before initiating dapagliflozin therapy, it is crucial to assess several key health conditions to ensure safe and effective use of the medication. The most critical assessments include:

• Renal function: Check estimated glomerular filtration rate (eGFR), as dapagliflozin is not recommended for patients with eGFR < 25 mL/min/1.73 m² for kidney and cardiovascular benefits, and initiation is not recommended with eGFR < 20 mL/min/1.73 m² 1.
• Cardiovascular status: Assess for history of heart failure or cardiovascular disease, as dapagliflozin has been shown to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with chronic kidney disease (CKD) 1.
• Urinary tract infections: Screen for current or recurrent UTIs, as dapagliflozin may increase the risk.
• Genital mycotic infections: Evaluate history of genital yeast infections, particularly in women.
• Volume status: Check for signs of dehydration or hypovolemia.
• Ketoacidosis risk: Assess for factors that may increase risk of diabetic ketoacidosis.
• Liver function: Perform liver function tests to ensure adequate hepatic function.
• Bone health: Consider bone mineral density in patients at risk for osteoporosis.
• Amputation risk: Evaluate for peripheral vascular disease or neuropathy.
• Medication interactions: Review current medications for potential interactions.

These assessments are vital because dapagliflozin, as an SGLT2 inhibitor, affects renal glucose reabsorption and can impact fluid balance, urinary glucose excretion, and ketone production. Proper evaluation ensures safe and effective use of the medication while minimizing potential risks, as supported by the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, which demonstrated a significant benefit of dapagliflozin in reducing the risk of adverse kidney and cardiovascular outcomes 1.

From the FDA Drug Label

Before initiating DAPAGLIFLOZIN TABLETS, assess volume status and renal function in the elderly, patients with renal impairment or low systolic blood pressure, and in patients on diuretics. Assess renal function prior to initiation and then as clinically indicated. Assess volume status and correct volume depletion before initiating.

The health conditions that should be assessed before initiating dapagliflozin (Forxiga) therapy include:

• Renal function: Assess renal function prior to initiation and then as clinically indicated.
• Volume status: Assess volume status and correct volume depletion before initiating, especially in the elderly, patients with renal impairment or low systolic blood pressure, and in patients on diuretics. 2

From the Research

Health Conditions to be Assessed before Initiating Dapagliflozin Therapy

Before initiating dapagliflozin (Forxiga) therapy, several health conditions should be assessed, including:

• Chronic kidney disease (CKD) and its severity, as dapagliflozin has been shown to reduce the risk of end-stage renal disease in patients with CKD 3, 4
• Heart failure, particularly heart failure with reduced ejection fraction (HFrEF), as dapagliflozin has been found to reduce the risk of cardiovascular death and hospitalization for heart failure in these patients 5, 6
• Cardiovascular disease, as dapagliflozin has been shown to reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes and high cardiovascular risk 7
• Type 2 diabetes, as dapagliflozin is approved for the management of type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise to improve glycemic control in adults 7
• Estimated glomerular filtration rate (eGFR), as dapagliflozin has been found to slow the rate of decline in eGFR in patients with HFrEF and CKD 5, 6

Key Considerations

When assessing these health conditions, the following key considerations should be taken into account:

• The presence and severity of CKD, as well as the patient's eGFR, should be evaluated to determine the potential benefits and risks of dapagliflozin therapy 3, 4
• The patient's cardiovascular risk profile, including the presence of heart failure, should be assessed to determine the potential benefits of dapagliflozin in reducing cardiovascular events 5, 6
• The patient's glycemic control and diabetes status should be evaluated to determine the potential benefits of dapagliflozin in improving glycemic control 7