Ceiling Doses for Dapagliflozin and Sitagliptin
The maximum approved daily dose is 10 mg for dapagliflozin and 100 mg for sitagliptin, and these doses can be safely combined without requiring adjustment of either medication. 1, 2
Standard Dosing Regimens
Dapagliflozin Maximum Dose
- 10 mg once daily is the ceiling dose for all indications including glycemic control, heart failure, and chronic kidney disease 1, 3, 4
- For glycemic control specifically, initiate at 5 mg once daily and may increase to 10 mg once daily if additional glucose lowering is needed 4, 2
- For cardiovascular and renal protection, use the fixed dose of 10 mg once daily without titration 3, 4
Sitagliptin Maximum Dose
- 100 mg once daily is the ceiling dose for all patients with normal renal function 1
- No dose titration is required or recommended above 100 mg daily 1
Combination Therapy Considerations
Safety of Combined Use
- Dapagliflozin and sitagliptin can be co-administered without dose adjustment of either drug, as there is no pharmacokinetic interaction between them 5
- The combination of dapagliflozin 10 mg plus sitagliptin 100 mg once daily demonstrated significant efficacy and was well tolerated in clinical trials 2, 6
- When adding dapagliflozin to existing sitagliptin therapy, no preemptive dose reduction is needed as the combination has low hypoglycemia risk 3
Clinical Evidence for Combination
- In a 24-week trial, dapagliflozin 10 mg added to sitagliptin 100 mg (with or without metformin) reduced HbA1c by 0.5% compared to placebo 2, 6
- The combination provided additional benefits in fasting plasma glucose reduction and body weight loss of approximately 2.1 kg 6
- Benefits observed at 24 weeks were maintained through 48 weeks of treatment 6
Renal Dosing Adjustments
Dapagliflozin Renal Considerations
- For eGFR ≥45 mL/min/1.73 m², use full doses (5-10 mg daily) for glycemic control without adjustment 3, 4
- For eGFR 25-44 mL/min/1.73 m², dapagliflozin 10 mg can still be used for cardiovascular/renal protection but is not recommended for glycemic control 3, 4
- Do not initiate dapagliflozin if eGFR <25 mL/min/1.73 m², though may continue 10 mg daily if eGFR falls below this threshold during treatment 3, 4
Sitagliptin Renal Considerations
- For eGFR ≥45 mL/min/1.73 m², continue sitagliptin 100 mg daily without adjustment 3
- For eGFR 30-44 mL/min/1.73 m², reduce sitagliptin to 50 mg once daily 3
- For eGFR <30 mL/min/1.73 m², reduce sitagliptin to 25 mg once daily 3
Important Safety Precautions
Monitoring Requirements
- Check eGFR before initiating dapagliflozin and recheck within 1-2 weeks after initiation 3
- Assess volume status before starting dapagliflozin and correct any volume depletion first 3, 4
- Monitor for genital mycotic infections (occur in approximately 6-10% of patients on dapagliflozin vs 0.4-1% on placebo) 3, 6
Critical Precautions
- Withhold dapagliflozin at least 3 days before major surgery or procedures requiring prolonged fasting to prevent ketoacidosis 3, 4
- Temporarily discontinue dapagliflozin during acute illness with reduced oral intake, fever, vomiting, or diarrhea 3
- Consider reducing concurrent diuretic doses when initiating dapagliflozin to prevent excessive volume depletion 3, 4