Experiences with
Dapagliflozin

Dapagliflozin is mainly used to treat type 2 diabetes.

It can also be used to treat heart failure and chronic kidney disease (CKD).

Dapagliflozin is usually prescribed if:

you have type 2 diabetes and cannot take metformin
the medicine you have been taking is not controlling your blood sugar properly – this may mean taking dapagliflozin with other diabetes medicines at the same time
you have heart failure – it can reduce the risk of the heart getting weaker, and help symptoms such as tiredness
you have chronic kidney disease – it helps to slow the rate at which the condition gets worse

Dapagliflozin is only available on prescription and comes as tablets.

Dapagliflozin also comes combined with other diabetes medicines. Brand names include Xigduo (dapagliflozin with metformin) and Qtern (dapagliflozin with saxagliptin).

Who can take dapagliflozin

Most adults can take dapagliflozin.

Most children aged 10 years old and over can take it for type 2 diabetes.

Who may not be able to take dapagliflozin

Dapagliflozin is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to dapagliflozin or any other medicine
have sugar (glucose) and ketones (a type of chemical) in your pee – there are home tests for this
have kidney or liver disease
have low blood pressure (hypotension)
often get urinary tract infections (UTIs)
are due to have surgery
are pregnant, trying to get pregnant or breastfeeding

Dosage and strength

For type 2 diabetes, the usual dose of dapagliflozin for adults and children aged 10 years old and over is 10mg, taken once a day. Your doctor may start you off on a lower dose of 5mg.

If you're taking a combination tablet (dapagliflozin with metformin or dapagliflozin with saxagliptin), the doses may vary.

Dosage for heart failure

For heart failure, the usual dose for adults is 10mg, taken once a day.

Dosage for chronic kidney disease

For chronic kidney disease, the usual dose for adults is 10mg, taken once a day.

Taking dapagliflozin with metformin (Xigduo)

There are 2 strengths of Xigduo. Each tablet contains 5mg of dapagliflozin but they contain different amounts of metformin. One contains 850mg of metformin and the other contains 1g.

Your doctor will prescribe the strength with the right amount of metformin for you.

The usual dose is 1 tablet, taken twice a day.

Taking dapagliflozin with saxagliptin (Qtern)

There's only 1 strength of Qtern. Each tablet contains 10mg of dapagliflozin and 5mg of saxagliptin.

The usual dose is 1 tablet, taken once a day.

How to take it

You can take dapagliflozin any time of day, just try to take it at the same time every day.

Swallow the tablets whole with a drink of water. Do not chew them. You can take them with or without food.

But if you're taking dapagliflozin with metformin, it's a good idea to take it with food or just after. This is because metformin is more likely to affect your stomach.

How long to take it for

Treatment for diabetes, heart failure and chronic kidney disease is usually for life.

Do not stop taking your dapagliflozin tablets without talking to your doctor first. If you stop taking it suddenly, your condition may get worse.

If this medicine is not working for you or you're bothered by side effects, speak to your doctor. They may be able to recommend another medicine to treat your diabetes.

If you forget to take it

If you miss a dose of dapagliflozin or Qtern and it's 12 hours or more until your next dose, take it as soon as you remember. Then take your next dose at the usual time.

If it's less than 12 hours until your next dose, skip the missed dose. Then take your next dose at the usual time.

If you miss a dose of Xigduo, take it as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

If you take more than your prescribed dose of dapagliflozin tablets, contact your doctor straight away. Taking too much can cause low blood sugar.

If you think you have low blood sugar, have some food or drink that quickly gets sugar into your bloodstream (like sugar cubes or fruit juice).

This type of sugar will not stay in your blood for long. You may also need to eat a starchy carbohydrate, like a sandwich or a couple of biscuits.

Common side effects

These common side effects of dapagliflozin happen in more than 1 in 100 people. They're usually mild and do not last long. There are things you can do to help cope with them:

Ask your pharmacist to recommend an antifungal treatment for thrush. If this does not work within a week or you keep getting thrush, speak to your doctor. There are also things you can do to prevent thrush returning.

If you get sudden unexpected back pain, do not try to treat it yourself. Contact your doctor – it might be a sign of a urinary tract infection (UTI).

This is a sign that you're peeing out more sugar in your urine. If this side effect bothers you, talk to your doctor or pharmacist.

Stop what you're doing and sit or lie down until you feel better. Do not drive, ride a bike or use tools or machines if you feel dizzy or shaky.

It may help to take an antihistamine. Check with a pharmacist to see what type is suitable for you. Speak to your doctor if the rash does not go away, or gets worse.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Low blood sugar

If you take dapagliflozin with other diabetes medicines, including insulin or sulfonylureas like gliclazide, your blood sugar can sometimes go too low. This is called hypoglycaemia or a "hypo".

Early warning signs of low blood sugar include:

feeling hungry
trembling or shaking
sweating
confusion
difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar can happen if you:

take more than your prescribed dose of some types of diabetes medicines
skip meals, have them at unusual times or you're fasting
do not eat a healthy diet and are not getting enough nutrients
change what you eat
increase your physical activity without eating more to compensate
drink alcohol, especially after skipping a meal
take some other medicines or herbal remedies at the same time
have a hormone disorder, such as an underactive thyroid (hypothyroidism)
have kidney or liver problems

It's important to have regular meals, including breakfast, to prevent hypoglycaemia. Never miss or delay a meal.

Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.

You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

If taking in sugar does not help or the hypo symptoms come back, contact your doctor or the nearest hospital.

Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious side effects

Diabetic ketoacidosis (DKA)

DKA is what happens when your body starts to run low on insulin and harmful substances, called ketones, build up in the body. Signs of DKA can include:

feeling or being sick
feeing very thirsty
feeling confused or unusually tired
having stomach pain
breath that smells fruity (like pear drop sweets, or nail varnish)
breathing more deeply or faster

Symptoms usually develop over 24 hours, but can come on faster. Your doctor will show you how to monitor your ketone and blood sugar levels, and what to do if this happens. You'll learn how to recognise the symptoms of DKA and what to do about it.

Other serious side effects

Apart from DKA for people with type 2 diabetes, serious side effects of dapagliflozin are rare and happen in less than 1 in 10,000 people.

If you have type 2 diabetes, you will get an alert card. This is to show any health professionals involved in your care.

Call your doctor or call 111 now if:

you have a very dry or sticky mouth, feel very thirsty, sleepy or tired, are not peeing (or peeing very little), and have a fast heartbeat – these can be signs of dehydration
you have a high temperature or feel cold and shivery, get a burning feeling when peeing, have pain in your back or side, or blood in your urine – these can be signs of a urinary tract infection (UTI)
you get severe pain, tenderness, redness, or swelling in the groin or perineal area accompanied by a high temperature or feeling unwell – this may be a sign of a serious infection called Fournier's gangrene

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to dapagliflozin.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of dapagliflozin. For a full list, see the leaflet inside your medicines packet.

Pregnancy and dapagliflozin

Dapagliflozin is not recommended as there is little information about its use in pregnancy. Other medicines used to treat diabetes, such as insulin and metformin, are safe to take in pregnancy.

Talk to your doctor or pharmacist before taking dapagliflozin. They will need to review your treatment and may be able to suggest an alternative medicine for you.

Dapagliflozin and breastfeeding

Dapagliflozin is not usually recommended while you're breastfeeding because we do not know how much of it passes into breast milk, but it is likely to be a small amount.

It is possible that dapagliflozin could lower your baby's sugar level and could affect the way their kidneys develop and grow.

Speak to your doctor about what's best for you and your baby. They will need to review your treatment and may be able to suggest an alternative medicine for you, particularly while you're breastfeeding a newborn or premature baby.

If your doctor says it's OK to continue breastfeeding while taking dapagliflozin, talk to your health visitor, midwife, doctor or pharmacist as soon as possible if your baby:

is not feeding as well as usual
is more sleepy or drowsy
is more restless or irritable
seems hungrier or more thirsty
is peeing more
is causing you any other concerns

Dapagliflozin and fertility

There's no evidence that dapagliflozin affects fertility in men or women.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may increase the effects of dapagliflozin. This can make you more likely to get side effects.

Tell your doctor if you're taking any of these medicines before you start taking dapagliflozin:

medicines that make you pee more (diuretics), like furosemide – these can increase your risk of dehydration and lower your blood pressure
ramipril or amlodipine, medicines for high blood pressure
other medicines that can lower your blood pressure – including some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), tamsulosin (for an enlarged prostate), or co-careldopa or levodopa (for Parkinson's disease)
medicines that cause low blood sugar, such as insulin or gliclazide – your doctor may lower your dose of these other medicines to prevent hypos

Taking dapagliflozin with painkillers

It's OK to take paracetamol with dapagliflozin, but ask your doctor or pharmacist before taking ibuprofen or aspirin with this medicine. This is because these medicines can sometimes lower your blood sugar levels.

Mixing dapagliflozin with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with dapagliflozin. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert