Dapagliflozin and Gliclazide Dosing Regimens
Yes, dapagliflozin is administered once daily at a fixed dose of 10 mg, but gliclazide should not be given three times daily—it is dosed either once or twice daily depending on the formulation. 1, 2
Dapagliflozin Dosing
Dapagliflozin is administered as a single 10 mg oral dose once daily, taken at any time of day with or without food. 2, 3
No dose titration is required for any indication—the 10 mg once-daily dose is used for glycemic control, heart failure, and chronic kidney disease. 2, 4
Pharmacokinetic studies confirm that once-daily dosing provides sustained SGLT2 inhibition and urinary glucose excretion over 24 hours, with a half-life of 10–17 hours. 5, 6
Although twice-daily dapagliflozin 5 mg produces similar total drug exposure (AUC) and urinary glucose excretion compared to 10 mg once daily, the once-daily regimen is the approved and clinically recommended schedule. 7
Gliclazide Dosing
Standard gliclazide (immediate-release) is typically dosed once or twice daily, not three times daily. 1
Modified-release (MR) gliclazide formulations are designed for once-daily administration. 1
Three-times-daily dosing of gliclazide is not a standard or recommended regimen and would increase the risk of hypoglycemia without improving glycemic control. 1
Clinical Considerations When Combining These Agents
If gliclazide is added to dapagliflozin, reduce the gliclazide dose or discontinue it entirely when baseline HbA1c is <8.5%, because the combination increases hypoglycemia risk without providing cardiovascular or renal benefit. 2
Dapagliflozin provides superior cardiovascular and renal protection compared to sulfonylureas like gliclazide, which offer no mortality or organ-protection benefits. 2, 3
When initiating dapagliflozin in a patient already on gliclazide, monitor blood glucose closely for the first 2–4 weeks and adjust sulfonylurea doses as needed. 2
Common Pitfalls to Avoid
Do not prescribe gliclazide three times daily—this is not a validated dosing schedule and increases the risk of hypoglycemia. 1
Do not combine dapagliflozin with gliclazide in patients with eGFR <45 mL/min/1.73 m², as dapagliflozin's glucose-lowering efficacy is reduced and the sulfonylurea adds hypoglycemia risk without cardiorenal benefit. 2
Do not split or titrate the dapagliflozin dose—10 mg once daily is the evidence-based regimen for all indications. 2, 4