Adults

Initially, one tablet (Dapagliflozin 5 mg/Metformin 500 mg) once daily. Dosage may be increased based on efficacy and tolerability, up to a maximum of Dapagliflozin 10 mg/Metformin 2000 mg daily.

Elderly

Close monitoring of renal function is recommended. Start with a lower dose if renal impairment is present.

Renal_impairment

Not recommended for patients with eGFR < 30 mL/min/1.73 m². Dose adjustment required for eGFR 30-45 mL/min/1.73 m² (Metformin contraindicated). Dapagliflozin can be used down to eGFR 25 mL/min/1.73 m² for specific indications.

Onset

Dapagliflozin: Glucosuric effect within 30 minutes. Metformin: Glucose lowering effect within hours.

Excretion

Dapagliflozin: Primarily renal (75% as metabolites), fecal (21%). Metformin: Primarily renal, excreted unchanged.

Half life

Dapagliflozin: ~12.9 hours. Metformin: ~6.2 hours (plasma elimination).

Absorption

Dapagliflozin: Rapidly absorbed, bioavailability ~78%. Metformin: Slowly and incompletely absorbed, bioavailability ~50-60%.

Metabolism

Dapagliflozin: Primarily metabolized by UGT1A9 to inactive metabolites. Metformin: Excreted unchanged in urine, not metabolized.

Loop Diuretics

May increase risk of dehydration and hypotension with Dapagliflozin.

Iodinated Contrast Agents

Metformin should be withheld before or at the time of the procedure and for 48 hours afterward in patients with an eGFR between 30 and 60 mL/min/1.73 m².

Carbonic Anhydrase Inhibitors

May increase risk of lactic acidosis with Metformin.

Insulin or Insulin Secretagogues

Increased risk of hypoglycemia with Dapagliflozin, dose adjustment may be needed.