Dapagliflozin Dosing Schedule
Take dapagliflozin 10 mg orally once daily in the morning for cardiovascular and renal protection, or start with 5 mg once daily (increasing to 10 mg if needed) for glycemic control in type 2 diabetes. 1
Standard Dosing by Indication
For Cardiovascular/Renal Protection (Heart Failure, CKD, or CV Risk Reduction)
- Fixed dose of 10 mg orally once daily 2, 3, 1
- No dose titration needed—cardiovascular and renal benefits occur at this single dose 2, 3
- This applies to heart failure (any ejection fraction), chronic kidney disease, or diabetes with established cardiovascular disease 3, 4, 1
For Glycemic Control in Type 2 Diabetes
- Start with 5 mg orally once daily 1
- May increase to 10 mg once daily if additional glucose lowering is needed 1
- The 10 mg dose provides maximal glycemic benefit without additional cardiovascular advantage beyond what 10 mg already offers 2, 3
Timing of Administration
Take dapagliflozin once daily in the morning, though evening dosing is also acceptable based on patient preference 5. The medication can be taken with or without food, as food does not significantly affect absorption 6. Peak plasma concentrations occur within 2 hours of administration 6.
Renal Function Considerations
For Glycemic Control
- eGFR ≥45 mL/min/1.73 m²: Use standard dosing (5-10 mg daily) 2, 1
- eGFR <45 mL/min/1.73 m²: Do NOT use for glycemic control—the drug is ineffective due to its mechanism of action 2, 4, 1
For Cardiovascular/Renal Protection
- eGFR ≥25 mL/min/1.73 m²: Use 10 mg daily regardless of glycemic efficacy 3, 4, 1
- eGFR <25 mL/min/1.73 m²: Do NOT initiate, but may continue 10 mg daily if already on treatment 3, 4, 1
- An initial eGFR dip of 3-5 mL/min/1.73 m² within 1-4 weeks is expected and reversible—do not discontinue for this alone 4
Critical Safety Precautions
Before Starting Dapagliflozin
- Assess volume status and correct depletion before initiation 1
- Consider reducing diuretic doses to prevent excessive volume depletion 2, 3, 4
- Reduce insulin by ~20% or wean sulfonylureas to prevent hypoglycemia 2, 3
When to Hold Dapagliflozin
- Withhold at least 3 days before major surgery or prolonged fasting to prevent postoperative ketoacidosis 2, 3, 4, 1
- Hold during acute illness with fever, vomiting, diarrhea, or reduced oral intake 4
- Hold during hospitalization for acute illness 4
- Resume only after recovery and normal oral intake is re-established 4
Common Pitfalls to Avoid
Do not discontinue dapagliflozin solely because eGFR falls below 45 mL/min/1.73 m²—cardiovascular and renal protective benefits persist even when glycemic efficacy is lost 4. The DAPA-CKD trial demonstrated 39% reduction in kidney disease progression and 29% reduction in cardiovascular death/heart failure hospitalization in patients with eGFR 25-75 mL/min/1.73 m² 3, 4.
Do not reduce the 10 mg dose for heart failure or CKD indications—all outcome trials used this fixed dose, and there is no evidence of dose-response for cardiovascular/renal benefits 2, 3.
Do not forget to educate patients about genital mycotic infections (occur in ~6% vs 1% placebo) and the rare but serious risk of euglycemic diabetic ketoacidosis, which can occur even with normal blood glucose 2, 4.