Dapagliflozin Disease Interactions

There is insufficient evidence to determine if dapagliflozin has an effect on preexisting bladder tumors or if it can cause bladder cancer. However, the manufacturer does not recommend the use of dapagliflozin in patients with active bladder cancer. In patients with history of bladder cancer the benefit of treatment versus the risk of cancer recurrence during treatment should be considered.

The glucose lowering effects of SGLT-2 inhibitors is decreased in patients with worsening renal function. Additionally, SGLT-2 inhibitors increase serum creatinine and decrease eGFR. The elderly and patients with moderate renal impairment are at increased risk of further renal dysfunction. Renal function should be evaluated before treatment initiation and monitored regularly in these patients. The use of SGLT-2 inhibitors in patients with severe renal impairment, end stage renal dysfunction (ESRD), or undergoing dialysis is contraindicated. Based on its mechanism of action, SGLT-2 inhibitors are not expected to be effective in patients with this level of renal dysfunction.

There have been reports of dose-related increases in LDL cholesterol with the use of SGLT-2 inhibitors. Cholesterol levels should be monitored before and during treatment and appropriate therapy should be initiated if needed.

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