Dapagliflozin Disease Interactions

Sodium-glucose cotransporter 2 (SGLT2) inhibitors ertugliflozin and canagliflozin are not recommended for use in patients with severe hepatic impairment due to lack of clinical data. Dapagliflozin has not been studied in patients with severe hepatic impairment and caution is recommended. Dosage adjustments are not necessary in patients with mild or moderate hepatic impairment.

The glucose lowering effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors is decreased in patients with worsening renal function. Additionally, patients with renal impairment function (eGFR less than 60 mL/min/1.73 m2) the elderly, and patients on loop diuretics may be more likely to experience adverse reactions related to volume depletion such as hypotension and acute kidney injury during therapy. Renal function should be evaluated prior to treatment initiation and monitored regularly in at-risk patients. Assess volume status and correct volume depletion before initiating therapy. The use of SGLT-2 inhibitors in patients undergoing dialysis is contraindicated. In both patients with and without type 2 diabetes, beneficial effects in chronic kidney disease and heart failure have been observed with SGLT2 inhibitor therapy. The manufacturer's product labeling should be consulted for indication specific renal dosing for SGLT2 inhibitors.

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors cause intravascular volume contraction which may lead to symptomatic hypotension after treatment initiation especially in the elderly, in patients with impaired renal function, patients with low systolic blood pressure, or those using diuretics . Volume status should be assessed and corrected before starting treatment and patients should be monitored during therapy.

An increase in the risk of genital mycotic infections has been reported with the use of a sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Care should be exercised when using this agent in patients who have a history of genital mycotic infections or who are uncircumcised as these patients are more likely to develop genital mycotic infections. Monitor and treat appropriately.