Can I use Dapagliflozin (SGLT2 inhibitor) and Glipizide (sulfonylurea) in a Heart Failure (HF) patient?

From the Guidelines

Yes, you can use dapagliflozin (an SGLT2 inhibitor) and glipizide (a sulfonylurea) together in a heart failure patient, but caution is warranted. Dapagliflozin is actually beneficial for heart failure patients, even those without diabetes, as it reduces cardiovascular mortality and hospitalization risk, as shown in the DAPA-HF trial 1. The typical dose is 10 mg once daily. Glipizide, on the other hand, should be used cautiously in heart failure patients, starting at a low dose (typically 2.5-5 mg daily) and monitoring closely, as recommended in the management of diabetic kidney disease 1. The combination may increase hypoglycemia risk, so blood glucose monitoring is essential. Patients should be educated about hypoglycemia symptoms and management. Additionally, monitor renal function, as dapagliflozin requires adequate kidney function to be effective and safe, with a recommended dose adjustment for patients with eGFR <45 mL/min/1.73 m2 1. Dapagliflozin works by promoting glucose excretion through the kidneys while also providing cardioprotective effects through mechanisms like reduced preload, improved cardiac metabolism, and anti-inflammatory actions. Glipizide stimulates insulin release from the pancreas, which can effectively lower blood glucose but carries hypoglycemia risk, especially in patients with compromised cardiac function who may have altered medication metabolism.

Some key points to consider when using this combination include:

• Monitoring for signs of hypoglycemia and educating the patient on its management
• Regular assessment of renal function to adjust the dose of dapagliflozin as needed
• Being aware of the potential for diabetic ketoacidosis, especially in patients with type 1 diabetes or those undergoing significant changes in insulin doses or nutrition plans 1
• Considering the benefits of SGLT2 inhibitors in reducing the risk of heart failure hospitalization and cardiovascular death, as demonstrated in several large outcomes trials, including EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and DAPA-HF 1.

Overall, the use of dapagliflozin and glipizide together in a heart failure patient can be beneficial, but it requires careful consideration of the potential risks and close monitoring to minimize adverse effects.

From the Research

Use of Dapagliflozin and Glipizide in Heart Failure Patients

• Dapagliflozin, an SGLT2 inhibitor, has been shown to reduce the risk of worsening heart failure or cardiovascular death in patients with heart failure, regardless of the presence or absence of diabetes mellitus 2, 3, 4.
• The DAPA-HF and EMPEROR-Reduced trials demonstrated that dapagliflozin reduces worsening heart failure or cardiovascular death by 26% 2, 4.
• Dapagliflozin has been approved for the treatment of adults with symptomatic heart failure with reduced ejection fraction, and is considered a valuable addition to the treatment options for these patients 3, 4.
• Glipizide, a sulfonylurea, is used to lower blood glucose levels in patients with type 2 diabetes, but its use in heart failure patients is not directly addressed in the provided studies.
• However, the use of SGLT2 inhibitors, such as dapagliflozin, in combination with other glucose-lowering therapies, including sulfonylureas like glipizide, may be considered in patients with heart failure and diabetes, as long as the patient's glucose levels are closely monitored and the benefits and risks of the combination therapy are carefully weighed 5.

Efficacy and Safety of Dapagliflozin in Heart Failure Patients

• Dapagliflozin has been shown to be effective in reducing the risk of hospitalization for heart failure and cardiovascular death in patients with heart failure, regardless of the presence or absence of diabetes mellitus 3, 6.
• The drug has been found to be generally well-tolerated, with an overall safety profile consistent with its known safety profile in other indications 3, 6.
• The incidence of adverse events was similar in patients treated with dapagliflozin and those treated with placebo in clinical trials 6.

Considerations for Use in Clinical Practice

• The use of dapagliflozin in heart failure patients should be considered in the context of the patient's individual clinical profile, including the presence or absence of diabetes mellitus, and the patient's renal function 3, 5.
• The benefits and risks of combining dapagliflozin with other glucose-lowering therapies, including sulfonylureas like glipizide, should be carefully weighed, and the patient's glucose levels should be closely monitored 5.