Adults

The recommended starting dose is 5 mg once daily, in the morning, with or without food. The dose can be increased to 10 mg once daily based on efficacy and tolerability.

Elderly

No dose adjustment is required based on age alone. However, renal function should be monitored due to the increased risk of renal impairment in elderly patients.

Renal_impairment

For type 2 diabetes, initiating treatment is not recommended if eGFR is <45 mL/min/1.73 m². For heart failure and CKD, a 10 mg dose is typically used, but monitor renal function carefully. Not recommended if eGFR <25 mL/min/1.73 m².

Onset

Glucose-lowering effects observed within 30-60 minutes.

Excretion

Approximately 75% of the administered dose is excreted in the urine (primarily as metabolites) and 21% in the feces.

Half life

The mean terminal half-life in healthy subjects is approximately 12.9 hours.

Absorption

Rapidly absorbed after oral administration, with peak plasma concentrations (Cmax) typically achieved within 0.5-2 hours. Absolute oral bioavailability is approximately 78%.

Metabolism

Extensively metabolized, primarily by uridine diphosphate glucuronosyltransferase 1A9 (UGT1A9) to form inactive dapagliflozin 3-O-glucuronide. It does not inhibit or induce CYP450 enzymes.

Lithium

SGLT2 inhibitors may decrease serum lithium concentrations. Monitor serum lithium concentration more frequently after initiating dapagliflozin.

Diuretics

Co-administration with diuretics may increase the risk of dehydration and hypotension.

Insulin and Insulin Secretagogues (e.g., Sulfonylureas)

May increase the risk of hypoglycemia. A lower dose of insulin or an insulin secretagogue may be required.