[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/) › Dapagliflozin

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# 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)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/)
- 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](https://www.rcsb.org/structure/8HEZ) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- Heart failure, with reduced or preserved ejection fraction [Heart failure →](https://durgical.com/en/conditions/heart-failure/)
- Chronic kidney disease at risk of progression [Chronic kidney disease →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Diabetic ketoacidosis, which may be euglycemic (glucose near normal): nausea, vomiting, abdominal pain, fast breathing, malaise
- Urosepsis and pyelonephritis
- Fournier gangrene (necrotizing fasciitis of the perineum): rare, life-threatening
- Acute kidney injury with volume depletion

## 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.

## Memory aid

Dapagliflozin: the '-gliflozin' suffix means 'glucose flows out'. Think of the three organs it helps: blood sugar, heart and kidney, and the three things that go wrong: yeast, dehydration and ketones.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/dapagliflozin/)

## Related drugs

- [Empagliflozin](https://durgical.com/en/pharmacology/empagliflozin/)
- [Canagliflozin](https://durgical.com/en/pharmacology/canagliflozin/)

## Related conditions

- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)

[← Back to the class: SGLT2 inhibitors (gliflozins)](https://durgical.com/en/pharmacology/classes/sglt2-inhibitors/)

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](https://medlineplus.gov/druginfo/meds/a614015.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - DAPAGLIFLOZIN tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b6b8a10c-64c3-4856-8961-d72d68784f5d) (DailyMed (U.S. National Library of Medicine), 2026); [Structure of human SGLT2-MAP17 complex with Dapagliflozin](https://www.rcsb.org/structure/8HEZ) (RCSB Protein Data Bank, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=A10BK01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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