What is the recommended dose of Dapavid (Dapagliflozin) for adults with type 2 diabetes?

Dapagliflozin (Dapavid) Dosing

The recommended dose of dapagliflozin for adults with type 2 diabetes is 10 mg orally once daily, taken at any time of day with or without food. 1

Standard Dosing by Indication

• For glycemic control in type 2 diabetes: Start with 5 mg once daily if eGFR ≥45 mL/min/1.73 m², with possible increase to 10 mg once daily if additional glycemic control is needed 2
• For cardiovascular and renal protection: Use a fixed dose of 10 mg once daily regardless of diabetes status, as there is no dose-response relationship for these benefits 1, 2
• No titration is required for cardiovascular or renal indications—the 10 mg dose provides maximal benefit 2

Renal Function-Based Dosing Algorithm

eGFR ≥45 mL/min/1.73 m²

• Initiate dapagliflozin without dose adjustment 1, 2
• Use 5-10 mg daily for glycemic control 2
• Use 10 mg daily for cardiovascular/renal protection 2

eGFR 25-44 mL/min/1.73 m²

• Do NOT initiate for glycemic control (ineffective due to mechanism of action) 1, 2
• DO initiate 10 mg daily for cardiovascular/renal protection based on DAPA-CKD trial evidence showing 39% reduction in kidney failure, cardiovascular death, or heart failure hospitalization 2
• If already on treatment, continue 10 mg daily 2

eGFR <25 mL/min/1.73 m²

• Do NOT initiate new therapy 2
• If already on treatment, continue 10 mg daily until dialysis is required 2

The key distinction here is that glucose-lowering efficacy diminishes below eGFR 45 mL/min/1.73 m², but cardiovascular and renal protective benefits persist down to eGFR 25 mL/min/1.73 m² 2. This is a common pitfall—clinicians often discontinue dapagliflozin when eGFR falls below 45, thereby losing the cardiovascular and renal benefits 2.

Dose Modifications When Adding to Existing Therapy

• If patient is on sulfonylureas or glinides: Reduce or stop these medications to prevent hypoglycemia 1
• If patient is on insulin: Consider reducing total daily insulin dose by approximately 20% when initiating dapagliflozin 1
• If patient is on diuretics: Consider reducing diuretic dose to prevent excessive volume depletion 2

Critical Safety Precautions

• Discontinue at least 3 days before planned surgery to prevent postoperative ketoacidosis 1, 2
• Hold during acute illness (fever, vomiting, diarrhea, reduced oral intake) to prevent diabetic ketoacidosis and volume depletion 2
• Maintain at least low-dose insulin in insulin-requiring patients even when dapagliflozin is held during illness 2

Monitoring Requirements

• Check eGFR within 1-2 weeks after initiation, as an initial dip of 3-5 mL/min/1.73 m² is expected and reversible 2
• Recheck eGFR every 3-6 months if eGFR 45-59 mL/min/1.73 m², or annually if eGFR ≥60 mL/min/1.73 m² 2
• Assess volume status before starting and monitor for signs of intravascular volume contraction 1, 2
• Monitor for genital mycotic infections (occur in ~6% vs 1% on placebo) and urinary tract infections 1, 2

Common Pitfalls to Avoid

• Do NOT discontinue dapagliflozin solely because eGFR falls below 45 mL/min/1.73 m²—cardiovascular and renal benefits persist even when glycemic efficacy is lost 2
• Do NOT use for glycemic control if eGFR <45 mL/min/1.73 m²—it will be ineffective 1, 2
• Do NOT forget to reduce insulin/sulfonylurea doses when initiating, as this increases hypoglycemia risk 1
• Do NOT continue through surgical procedures—must stop 3 days prior 1, 2

1, 2, 3