From the Guidelines
Dapagliflozin is not absolutely contraindicated in a female with a history of lower urinary tract infection (UTI), but caution is advised. According to the most recent and highest quality study, dapagliflozin can be prescribed to such patients, but with careful monitoring and patient education 1. The recommended starting dose is 10 mg once daily, as listed in the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1.
When prescribing dapagliflozin to a patient with a history of UTIs, consider the following:
- Educate the patient about UTI symptoms and the importance of prompt reporting
- Advise good genital hygiene practices
- Ensure adequate hydration
- Consider more frequent follow-ups, especially in the initial months of treatment
The reason for caution is that SGLT2 inhibitors like dapagliflozin can slightly increase the risk of genital and urinary tract infections, as they cause glucose excretion in the urine, which can promote bacterial growth 1. However, for most patients, the benefits of improved glycemic control and potential cardiovascular and renal benefits outweigh this manageable risk. If recurrent UTIs occur while on dapagliflozin, consider temporary discontinuation during active infections or switching to an alternative diabetes medication if infections become frequent or severe. The European Association of Urology guidelines on urological infections also emphasize the importance of clinical expertise in tailoring treatment decisions for individual patients, taking into account their unique circumstances and values 1.
From the FDA Drug Label
DAPAGLIFLOZIN TABLETS may cause serious side effects, including: • Serious urinary tract infections. Serious urinary tract infections that may lead to hospitalization have happened in people who are taking DAPAGLIFLOZIN TABLETS
Dapagliflozin (Forxiga) is not contraindicated in a female with a history of lower urinary tract infection (UTI). However, it may increase the risk of serious urinary tract infections, and patients should be monitored for signs and symptoms of UTIs, such as a burning feeling when passing urine, a need to urinate often, or pain in the lower part of the stomach (pelvis) 2.
From the Research
Dapagliflozin Contraindications
- Dapagliflozin is not directly contraindicated in females with a history of lower urinary tract infection (UTI) 3, 4, 5, 6, 7.
Urinary Tract Infection Risk
- The incidence of UTIs is higher in patients treated with dapagliflozin compared to those treated with placebo 3, 4, 5, 6.
- Female gender and older age are significant risk factors for UTIs in patients treated with SGLT2 inhibitors, including dapagliflozin 4.
- The majority of UTIs reported in clinical trials were mild to moderate and responded to standard antimicrobial treatment 5.
Special Considerations
- Patients with a history of UTIs should be monitored closely while taking dapagliflozin, as the risk of recurrent UTIs may be increased 6.
- Dapagliflozin should be used with caution in patients with a history of bladder cancer, as there may be an increased risk of bladder cancer with SGLT2 inhibitor use 3.