Pharmacology · SGLT2 inhibitors (gliflozins)

Dapagliflozin !

An SGLT2 inhibitor used in type 2 diabetes, heart failure and chronic kidney disease. Watch for genital infections and ketoacidosis.

Updated 2026-11-01

Class: SGLT2 inhibitors (gliflozins)
Transporter: Sodium-glucose cotransporter 2 (SGLT2)
ATC code: A10BK01
WHO Model List of Essential Medicines

Sodium-glucose cotransporter 2 (SGLT2)Dapagliflozin

The figure shows dapagliflozin bound to human SGLT2 (with MAP17) in the glucose-binding site.

Target in 3D: Sodium-glucose cotransporter 2 (SGLT2). PDB structure 8HEZ (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Dapagliflozin selectively blocks SGLT2 in the proximal tubule. Less filtered glucose and sodium are reabsorbed, so glucose leaves in the urine, blood glucose falls without extra insulin, and a mild osmotic diuresis and natriuresis follow. Restored tubuloglomerular feedback lowers glomerular hyperfiltration, which helps protect the kidney; reduced preload and afterload help the failing heart.

Binds SGLT2 on the luminal side of the proximal tubule
Filtered glucose and sodium are no longer reabsorbed
Glucose, calories and some fluid leave in the urine
Glucose falls; glomerular pressure and heart load drop

Pharmacokinetics

Absorption: Oral, well absorbed.
Metabolism: Mainly glucuronidation by UGT1A9 to an inactive metabolite.
Elimination: Mostly in urine as the metabolite; glucose lowering weakens as kidney function falls.
Half-life: Long enough for once-daily use.

Indications

Type 2 diabetes, with diet and exercise Type 2 diabetes mellitus →
Heart failure, with reduced or preserved ejection fraction Heart failure →
Chronic kidney disease at risk of progression Chronic kidney disease →

Adverse effects

Common

Genital fungal infections (vulvovaginal candidiasis, balanitis)
Urinary tract infections and more frequent urination
Thirst, dizziness and low blood pressure from fluid loss
A small, usually reversible fall in eGFR at the start

Contraindications

Hypersensitivity to the drug
Not used to control glucose in type 1 diabetes, because of ketoacidosis risk

Key interactions

Insulin or sulfonylureas: Higher risk of hypoglycemia; the other drug is often reduced.
Diuretics (loop or thiazide): Add to fluid loss and low blood pressure.
Lithium: Serum lithium can fall; levels are checked.
Urine glucose and 1,5-anhydroglucitol tests: Become unreliable for judging glucose control.

What is monitored

Kidney function before starting and as needed
Volume status and blood pressure
HbA1c
Genital and urinary symptoms

Administration and safety

Oral tablet, once a day, with or without food.
Volume status is checked and corrected before the first dose.
Usually paused before planned surgery and during acute illness or fasting, to prevent ketoacidosis.

Nursing care

Before: kidney function, blood pressure, hydration, genital and urinary symptoms.
During: signs of ketoacidosis even with normal glucose; ketones are measured if the patient feels unwell.
Teach genital hygiene and to report pain, redness or swelling of the genital or perineal area with fever.
Teach that urine glucose tests will be positive and that fluids matter in hot weather or with vomiting.

Pregnancy and breastfeeding

Not recommended in the second and third trimesters, based on kidney effects seen in animals; insulin is the usual choice in pregnancy.

Test yourself

Think of the answer, then tap the question to see it.

Can dapagliflozin be used in heart failure without diabetes?

Yes. Its benefit in heart failure (fewer hospitalizations and cardiovascular deaths) does not depend on having diabetes.

Which rare but severe infection is a warning for SGLT2 inhibitors?

Fournier gangrene, a necrotizing fasciitis of the perineum; pain, redness or swelling of the genital area with fever needs urgent care.

Why does adding dapagliflozin to a loop diuretic need care in an older adult?

Both remove salt and water, so dehydration, low blood pressure, falls and acute kidney injury become more likely.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Dapagliflozin: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - DAPAGLIFLOZIN tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); Structure of human SGLT2-MAP17 complex with Dapagliflozin (RCSB Protein Data Bank, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.