Should I Stop Dapagliflozin Now?
No—do not stop dapagliflozin unless you are acutely ill with reduced oral intake, fever, vomiting, diarrhea, or scheduled for major surgery within 3 days. 1, 2
When to Temporarily Hold Dapagliflozin ("Sick Day Rules")
Stop dapagliflozin immediately during any acute illness that reduces your ability to eat or drink normally, including fever, vomiting, or diarrhea, to prevent volume depletion and euglycemic diabetic ketoacidosis. 2
Withhold dapagliflozin at least 3 days before any major surgery or procedure requiring prolonged fasting (including coronary artery bypass grafting) to reduce the risk of perioperative ketoacidosis. 1, 2
Resume dapagliflozin only after you have fully recovered from the acute illness and re-established normal oral intake. 2
When to Continue Dapagliflozin Without Interruption
Continue dapagliflozin if your eGFR is ≥25 mL/min/1.73 m² for cardiovascular and renal protection, even if eGFR falls below 45 mL/min/1.73 m² (glucose-lowering efficacy diminishes but cardiorenal benefits persist). 2, 3
Do not stop dapagliflozin solely because of an expected early eGFR dip of 2–5 mL/min/1.73 m² within the first 2–4 weeks; this hemodynamic change is reversible and does not indicate kidney injury. 2
Continue dapagliflozin even if eGFR falls below 25 mL/min/1.73 m² in patients already on treatment, until dialysis is initiated, as cardiovascular and renal benefits remain. 2
Evidence Supporting Continuation
Dapagliflozin reduces the composite of sustained eGFR decline ≥50%, end-stage kidney disease, or renal/cardiovascular death by 39% (HR 0.61,95% CI 0.51–0.72) in patients with chronic kidney disease and albuminuria. 3
Cardiovascular death or heart failure hospitalization is reduced by 29% (HR 0.71,95% CI 0.55–0.92), and all-cause mortality by 31% (HR 0.69,95% CI 0.53–0.88). 3
These benefits are consistent regardless of diabetes status and persist across the spectrum of age, including in patients ≥75 years. 4
Critical Safety Warnings
Seek immediate medical attention if you develop malaise, nausea, vomiting, or abdominal pain even with normal blood glucose, as euglycemic diabetic ketoacidosis can occur. 2, 5
Contact your healthcare provider urgently if you develop fever, severe pain, or rapidly spreading redness in the genital or perineal area, as necrotizing fasciitis (Fournier's gangrene) is a rare but life-threatening complication requiring immediate discontinuation. 6, 5
Genital mycotic infections occur in approximately 6% of patients versus 1% with placebo; daily hygiene may reduce recurrence risk, but these infections are treatable and do not require stopping dapagliflozin unless they progress to necrotizing fasciitis. 2, 6, 7
Common Pitfalls to Avoid
Do not discontinue dapagliflozin when eGFR falls below 45 mL/min/1.73 m²; cardiorenal benefits persist despite loss of glycemic efficacy. 2
Do not reduce the dose below 10 mg for cardiovascular or renal indications, even at lower eGFR levels; all outcome trials used the fixed 10 mg dose. 2
Do not stop dapagliflozin because of a mild genital infection; treat the infection with over-the-counter antifungals and continue the medication for its life-saving cardiovascular and renal benefits. 6