1 *
2
3
SGLT2i dosing considerations according to eGFR when treating T2D , HF or CKD
This is a promotional piece from AstraZeneca . For Healthcare Professionals in Great Britain Only
eGFR ( ml / min / 1.73 m 2 )
SGLT2i Licensed Indication ��� 59 – 45 ����� ��� < 15
CONSIDER ADDITIONAL GLUCOSE LOWERING TREATMENT IN T2D controlled type 2 diabetes
In adults for the treatment of Start 10mg
Continue symptomatic chronic heart failure In patients with severe hepatic impairment , a starting dose of 5mg is recommended . If well tolerated , the dose may be increased to 10mg
In adults for the treatment of chronic kidney disease
CONSIDER ADDITIONAL GLUCOSE LOWERING TREATMENT IN T2D
Start 10mg Start 10mg only in Continue 10mg Start 10mg Continue 10mg in ( can increase to patients with T2D in patients only in patients with patients with T2D controlled type 2 diabetes 25mg ) a and eCVD with T2D T2D and eCVD and eCVD eGFR 20-30 eGFR < 20 In adults for the treatment of
Start 10mg Start 10mg symptomatic chronic heart failure
CONSIDER ADDITIONAL GLUCOSE LOWERING TREATMENT IN T2D
increase to 300mg ) until dialysis or renal transplantation controlled type 2 diabetes
†
Start 100mg ( can
b Start 100mg
Continue 100mg only if uACR > 300mg / g
SCAN HERE TO ACCESS RESOURCES TO SUPPORT YOUR PATIENTS AND YOUR PRACTICE
blood glucose level . �efore initiating dapagliflozin , factors in patient history that may predispose to ketoacidosis should be considered . Treatment should be interrupted in patients who are hospitalised for major surgical procedures or acute serious medical illnesses . Monitoring of ketones is recommended in these patient ’ s . Measurement of blood ketone level is preferred to urine . Treatment with dapagliflozin may be restarted when the ketone values are normal and the patient ’ s condition has stabilised . Rare cases of DKA , including life-threatening and fatal cases , have been reported in patients treated with SGLT2 inhibitors , including dapagliflozin . In a number of cases , the presentation of the condition was atypical with only moderately increased blood glucose values , below 14mmol / L ( 250mg / dL ). In patients where DKA is suspected or diagnosed , dapagliflozin treatment should be stopped immediately . Restarting SGLT2 inhibitor treatment in patients with previous DKA while on SGLT2 inhibitor treatment is not recommended , unless another clear precipitating factor is identified and resolved . Dapagliflozin should not be used for treatment of patients with type 1 diabetes . Necrotising fasciitis of the perineum ( Fournier ’ s �����������Post-marketing cases have been reported in female and male patients taking SGLT2 inhibitors . U rgent surgical intervention and antibiotic treatment required . Advise patients to seek medical attention if they experience a combination of pain , tenderness , erythema , or swelling in the genital or perineal area , with fever or malaise . Either uro‐genital infection or perineal abscess may precede necrotising fasciitis . If suspected discontinue Forxiga and institute prompt treatment ( including antibiotics and surgical debridement ). U rinary
tract infections : Temporary interruption of dapagliflozin should be considered when treating pyelonephritis or urosepsis . �������� ����� ������� Elderly patients are more likely to have impaired renal function , be treated with medicines such as anti-hypertensives or diuretics , and be at a greater risk of volume depletion . Cardiac failure : Experience with dapagliflozin in N�HA class I� is limited . Chronic kidney disease : There is no experience with dapagliflozin for the treatment of chronic kidney disease in patients without diabetes who do not have albuminuria . Dapagliflozin has not been studied for the treatment of chronic kidney disease in patients with polycystic kidney disease , glomerulonephritis with flares ( lupus nephritis or ANCA‐associated vasculitis ), ongoing or recent requirements of cytotoxic , immunosuppressive or other immunomodulating renal therapy , or in patients who received an organ transplant . ����������� amputations : Counsel patients with diabetes on routine preventative foot care . An increase in cases of lower limb amputation ( primarily of the toe ) has been observed in long-term , clinical studies with SGLT2 inhibitors . ������ ����������� ������������ Patients will test positive for glucose in the urine due to mechanism of action . �������� Patients with rare hereditary problems of galactose intolerance , total lactase deficiency , or glucose-galactose malabsorption should not take Forxiga .
Drug Interactions : Diuretics : Dapagliflozin may add to the diuretic effect of thiazide and loop diuretics and may increase the risk of dehydration and hypotension . Insulin and insulin secretagogues : Consider a lower dose of insulin or insulin secretagogue in combination with dapagliflozin to reduce the risk of hypoglycaemia . ���������������������������������������������������� Dapagliflozin may increase renal lithium excretion and the blood lithium levels may be decreased . Interference ������������������ Monitoring glycaemic control with 1,5-AG assay is not recommended as measurements of 1,5-AG are unreliable in assessing glycaemic control in patients taking SGLT2 inhibitors . Alternative methods should be used . ���������� ���� ���������� Not recommended during the second and third trimesters of pregnancy . Treatment should be discontinued when pregnancy is detected . Do not use whilst breast-feeding . ���������������������������������� Alert patients on the risk of hypoglycaemia when dapagliflozin is used in combination with a sulphonylurea or insulin . ������������������� Consult SmPC for full list of side effects . V ery common ( ≥1 / 10 ): Hypoglycaemia ( when used with S� or insulin ). Common ( ≥1 / 100 to < 1 / 10 ): �ulvovaginitis , balanitis and related genital infections , urinary tract infection , dizziness , rash , back pain ,
�������� ������� ������� ��� ���������� ���������� ������ ���� ������������ ���� ��� ������ ��� ��������������������������� ��� ������� ���� ����� ������� ����� ��� ���� ������� ����� ��� ������ ���� ������� �������� ������� ������� ����� ��� ��������� ��� ������������ ��� �������� ���������������������������������������������������������������������
dysuria , polyuria , haematocrit increased , creatinine renal clearance decreased during initial treatment , dyslipidaemia . U ncommon ( ≥1 / 1,000 to < 1 / 100 ): �olume depletion . Rare ( ≥ 1 / 10,000 to < 1 / 1,000 ): Diabetic ketoacidosis . V ery Rare (< 1 / 10,000 ): Angioedema , necrotising fasciitis of the perineum ( Fournier�s gangrene ), tubulointerstitial nephritis . ��������������� PO M . ������������������������������� Forxiga has GB licences . PLGB 179 01 / 0326 , PLGB 179 01 / 0325 . ������������������������������ Forxiga 5mg filmcoated tablets 2� : �36.5�� Forxiga 10mg film‐coated tablets 28 : £ 36.59 . Marketing Authorisation Holder : AstraZ eneca U K Ltd ., 1 Francis Crick Avenue , Cambridge , CB 2 0AA , U K . �������������������������������������� AstraZ eneca U K Ltd ., 2 Pancras S�uare , London , N1C 4AG , �� . FO RX IGA is a trademark of the AstraZ eneca group of companies . Date of preparation 12 / 2022 C� 22 0170
G�‐44041 � August 2023