What is the recommended dose of dapagliflozin (Forxiga) for a patient with type 2 diabetes?

Recommended Dosage of Dapagliflozin for Type 2 Diabetes

The recommended starting dose of dapagliflozin (Forxiga) for patients with type 2 diabetes is 5 mg orally once daily, which can be increased to 10 mg once daily for additional glycemic control if needed. 1

Standard Dosing Recommendations

• The FDA-approved starting dose for dapagliflozin in adults and pediatric patients aged 10 years and older with type 2 diabetes is 5 mg orally once daily 1
• For patients requiring additional glycemic control, the dose can be increased to 10 mg orally once daily 1
• Dapagliflozin should be taken at the same time each day to maintain consistent blood levels and optimize efficacy 2
• The medication works by inhibiting sodium-glucose co-transporter-2 (SGLT2) in the kidneys, reducing renal glucose reabsorption and increasing urinary glucose excretion 2, 3

Renal Function Considerations

• Prior to initiating dapagliflozin, renal function should be assessed 1
• For patients with eGFR ≥45 mL/min/1.73 m², the standard dosing recommendations apply 1
• Dapagliflozin is not recommended for glycemic control in patients with eGFR <45 mL/min/1.73 m² as it is likely to be ineffective in this setting 1
• For non-glycemic indications (cardiovascular or renal protection), dapagliflozin can be used in patients with eGFR ≥25 mL/min/1.73 m² 1

Special Considerations

• Volume status should be assessed before initiating dapagliflozin; in patients with volume depletion, this condition should be corrected before starting treatment 1
• Temporarily withhold dapagliflozin for at least 3 days prior to major surgery or procedures associated with prolonged fasting to reduce the risk of ketoacidosis 1
• Resume dapagliflozin when the patient is clinically stable and has resumed oral intake 1
• When adding dapagliflozin to insulin or insulin secretagogues (e.g., sulfonylureas), consider reducing the dose of these agents to minimize the risk of hypoglycemia 2, 3

Clinical Efficacy

• Clinical trials have demonstrated that dapagliflozin effectively reduces HbA1c by approximately 0.5-0.8% compared to placebo 4
• Dapagliflozin also provides additional benefits including weight reduction (typically 2-3 kg) and modest blood pressure lowering 4
• The glucose-lowering effect is maintained for up to 2 years with continued treatment 3, 4
• Dapagliflozin has a low risk of hypoglycemia when used as monotherapy or in combination with metformin 2, 4

Common Adverse Effects

• Genital infections and urinary tract infections occur more frequently with dapagliflozin compared to placebo due to its mechanism of action 2, 4
• Other potential adverse effects include volume depletion, particularly in elderly patients or those on diuretics 1
• The risk of diabetic ketoacidosis, while rare, should be considered, especially in situations of acute illness or surgical stress 1

Dapagliflozin's unique mechanism of action makes it a valuable option for type 2 diabetes management, particularly as add-on therapy when additional glycemic control is needed beyond first-line agents like metformin 2, 3.