What is the maximum dose of dapagliflozin (SGLT2 inhibitor) for an adult patient with type 2 diabetes and mild impaired renal function?

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Maximum Dose of Dapagliflozin

The maximum dose of dapagliflozin is 10 mg orally once daily for all indications, including type 2 diabetes, heart failure, and chronic kidney disease. 1, 2

Standard Dosing Across All Indications

  • For cardiovascular and renal protection: The fixed dose is 10 mg once daily, with no titration required or recommended, as all major outcome trials (DAPA-HF, DAPA-CKD, DECLARE-TIMI 58) used this single dose 1, 3, 2

  • For glycemic control in type 2 diabetes: The starting dose is 5 mg once daily, which may be increased to a maximum of 10 mg once daily if additional glucose lowering is needed 2, 3

  • For pediatric patients aged 10 years and older with type 2 diabetes: The same dosing applies—start at 5 mg daily, with a maximum of 10 mg daily 2

Renal Function Considerations

  • For patients with eGFR ≥45 mL/min/1.73 m²: The maximum dose remains 10 mg daily for all indications 2, 3

  • For patients with eGFR 25-44 mL/min/1.73 m²: The dose is still 10 mg daily for cardiovascular and renal protection, though glucose-lowering efficacy is reduced 2, 3

  • For patients with eGFR <25 mL/min/1.73 m²: Do not initiate dapagliflozin, but if already on treatment, 10 mg daily may be continued until dialysis is required 2, 3

Critical Distinction from Other SGLT2 Inhibitors

Unlike empagliflozin (which has 10 mg and 25 mg doses) or canagliflozin (which has 100 mg and 300 mg doses), dapagliflozin has only one therapeutic maximum: 10 mg daily 1, 4, 5. There is no evidence that higher doses provide additional cardiovascular, renal, or even glycemic benefits 3, 6, 7.

Common Pitfall to Avoid

Do not attempt to increase dapagliflozin beyond 10 mg daily in any clinical scenario—this is the ceiling dose established by pharmacokinetic studies showing maximal SGLT2 inhibition at doses of 20-50 mg, with 10 mg providing near-maximal effect for 24 hours 6, 8. The FDA-approved maximum is 10 mg, and no higher doses are available or recommended 2.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Dapagliflozin Dosing and Safety Considerations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Empagliflozin Dosing for Type 2 Diabetes Mellitus

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

SGLT2 Inhibitor Dosing and Management for CKD Stages 1/2

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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