From the Guidelines
Dapagliflozin commonly causes genital mycotic infections, urinary tract infections, volume depletion, and diabetic ketoacidosis as side effects, which can be managed with proper patient education, monitoring, and treatment adjustments, as recommended by the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Side Effects and Management
The most common side effects of dapagliflozin include:
- Genital mycotic infections, which can be managed with proper genital hygiene and antifungal treatments
- Urinary tract infections, which can be treated with antibiotics
- Volume depletion, which can be managed by monitoring hydration status and adjusting diuretic doses
- Diabetic ketoacidosis, which can be prevented by temporary discontinuation during acute illness or surgery
Patient Education and Monitoring
Patients should be educated about:
- Increased urination and potential for hypotension, especially when starting therapy
- Recognizing signs of genital infections (itching, discharge)
- Seeking immediate medical attention for symptoms of ketoacidosis (nausea, vomiting, abdominal pain, unusual fatigue) Regular monitoring of renal function is important, as dapagliflozin works by inhibiting SGLT2 receptors in the kidneys, causing glucose excretion in urine.
Treatment Adjustments
The medication should be temporarily stopped during periods of reduced oral intake or acute illness to reduce complication risks. Most side effects are manageable with proper patient education and monitoring, allowing continued benefit from dapagliflozin's glucose-lowering, cardiovascular, and renal protective effects, as supported by the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1.
From the FDA Drug Label
DAPAGLIFLOZIN TABLETS may cause serious side effects, including: • Serious urinary tract infections. • Low blood sugar (hypoglycemia) in patients with diabetes mellitus. • A rare but serious bacterial infection that causes damage to the tissue under the skin (necrotizing fasciitis) in the area between and around the anus and genitals (perineum) • Serious allergic reaction The most common side effects of DAPAGLIFLOZIN TABLETS include: • vaginal yeast infections and yeast infections of the penis • stuffy or runny nose and sore throat • changes in urination, including urgent need to urinate more often, in larger amounts, or at night
The common side effects of dapagliflozin (SGLT2 inhibitor) include:
- Vaginal yeast infections and yeast infections of the penis
- Stuffy or runny nose and sore throat
- Changes in urination, including urgent need to urinate more often, in larger amounts, or at night
- Serious urinary tract infections
- Low blood sugar (hypoglycemia) in patients with diabetes mellitus
- Necrotizing fasciitis of the perineum
- Serious allergic reaction
These side effects can be managed by:
- Monitoring for signs and symptoms of hypoglycemia and urinary tract infections
- Practicing good genital hygiene to prevent yeast infections
- Staying hydrated to prevent dehydration
- Seeking medical attention immediately if symptoms of necrotizing fasciitis or serious allergic reaction occur 2 2
From the Research
Common Side Effects of Dapagliflozin
- Genital fungal infections: Women and patients with a prior history of genital fungal infections are at a higher risk of developing genital fungal infections with dapagliflozin treatment 3.
- Urinary tract infections: Dapagliflozin has been associated with an increased risk of urinary tract infections, with a reported incidence of 6% of cases submitted to the Food and Drug Administration Adverse Event Reporting System database 4.
- Hypoglycemic episodes: Dapagliflozin has a low risk of hypoglycaemia, although the incidence varies depending on background therapy 5, 6.
- Weight loss: Dapagliflozin has been shown to reduce body weight in patients with type 2 diabetes 5, 6, 7.
Management of Side Effects
- Genital fungal infections: Patients should be counseled about the risk of genital fungal infections and monitored for signs and symptoms of infection 3, 4.
- Urinary tract infections: Patients should be advised to report any symptoms of urinary tract infections, such as dysuria or pyuria, to their healthcare provider 4.
- Hypoglycemic episodes: Patients should be educated on the signs and symptoms of hypoglycaemia and how to manage them 5, 6.
- Weight loss: Patients should be monitored for changes in body weight and advised on how to maintain a healthy weight 5, 6, 7.