Adults

Initial dose is 10 mg once daily in the morning, with or without food. May be increased to 25 mg once daily if additional glycemic control is needed and 10 mg is well tolerated. For cardiovascular/renal indications, 10 mg once daily is the recommended dose.

Elderly

No dose adjustment is required based on age alone. Caution is advised due to potential for volume depletion.

Renal_impairment

Initiation not recommended if eGFR < 20 mL/min/1.73m². If eGFR falls below 20 mL/min/1.73m² during treatment, continue 10 mg dose. No dose adjustment needed for mild to moderate impairment. For severe impairment (eGFR < 30 mL/min/1.73m²), consider specific guidelines; it is effective down to eGFR of 20 mL/min/1.73m² for heart failure and kidney disease indications.

Onset

Glycemic effect within hours, full therapeutic effect within days/weeks.

Excretion

Approximately 41% excreted in feces and 54% in urine, mainly as inactive metabolites. Renal clearance of unchanged drug is low.

Half life

Approximately 12.4 hours.

Absorption

Rapidly absorbed after oral administration, peak plasma concentrations (Cmax) reached within 1.5 hours.

Metabolism

Primarily metabolized by glucuronidation via UGT enzymes (UGT1A3, UGT1A8, UGT1A9, UGT2B7, UGT2B15).

Lithium

SGLT2 inhibitors may decrease serum lithium concentrations. Monitor serum lithium levels more frequently.

Diuretics

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

Insulin or Insulin Secretagogues

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