How and When to Take Dapagliflozin 10 mg

Take dapagliflozin 10 mg once daily in the morning, with or without food, at the same time each day. 1

Standard Dosing Schedule

The recommended dose is 10 mg orally once daily for cardiovascular protection, heart failure, and chronic kidney disease indications 1
For glycemic control in type 2 diabetes, start with 5 mg once daily, which can be increased to 10 mg once daily if additional glucose lowering is needed 1
Timing: Take in the morning as this was the primary dosing schedule studied in major clinical trials, though evening dosing is also effective 2, 3
Food does not affect absorption, so dapagliflozin can be taken with or without meals 1, 3

Initiate if eGFR ≥25 mL/min/1.73 m² for cardiovascular and renal protection indications 1, 4
For glycemic control only, initiate if eGFR ≥45 mL/min/1.73 m², as the drug is ineffective for glucose lowering below this threshold 1, 4
Assess volume status before starting and correct any volume depletion first, particularly in patients on diuretics or with low blood pressure 1, 4
Check renal function (eGFR) before initiation and periodically thereafter 1, 4

Withhold at least 3 days before major surgery or procedures requiring prolonged fasting to prevent postoperative ketoacidosis 1, 4
Stop immediately during acute illness with fever, vomiting, diarrhea, or reduced oral intake to prevent diabetic ketoacidosis and volume depletion 4
Resume only after recovery from illness and when normal oral intake is re-established 4

If eGFR falls below 25 mL/min/1.73 m² during treatment, continue 10 mg daily for cardiovascular and renal protection until dialysis is required 1, 4
Do not discontinue solely because eGFR drops below 45 mL/min/1.73 m², as cardiovascular and renal benefits persist even when glucose-lowering effects are lost 4

Recheck eGFR within 1-2 weeks after starting, as a transient dip of 3-5 mL/min/1.73 m² is expected and reversible 4
Monitor for genital mycotic infections (occur in ~6% of patients), which can be reduced with daily hygiene measures 4
Watch for signs of volume depletion, especially in elderly patients, those on diuretics, or with low blood pressure 1, 4
Educate about euglycemic diabetic ketoacidosis, which can occur even with normal blood glucose levels—seek immediate care if experiencing nausea, vomiting, or malaise 4, 1
Consider reducing concurrent diuretic doses when starting dapagliflozin to prevent excessive volume depletion 4

Do not stop dapagliflozin just because glucose control is adequate, as the cardiovascular and renal benefits are independent of glycemic effects 4, 5
Do not completely stop insulin in insulin-requiring patients during sick days, as this significantly increases ketoacidosis risk even when dapagliflozin is held 4
Do not assume the drug is ineffective if eGFR is low—benefits for heart failure and kidney protection persist at eGFR 25-44 mL/min/1.73 m² even though glucose lowering is minimal 4, 5