Dapagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor used for diabetes, heart failure, and chronic kidney disease.
It provides cardiovascular and renal benefit independent of glucose lowering.
Location: • Proximal convoluted tubule
Action: • Blocks SGLT2 transporter • Decreases glucose reabsorption • Increases urinary glucose excretion • Causes mild natriuresis
Physiologic effects: • ↓ Blood glucose • ↓ Intravascular volume • ↓ Blood pressure • ↓ Intraglomerular pressure • Improved cardiac energy efficiency
• Glycemic control • Reduces cardiovascular events • Promotes modest weight loss
Indicated for:
• HFrEF • HFpEF
Benefits: • ↓ HF hospitalization • ↓ Cardiovascular mortality • Effective in patients with or without diabetes
Part of the Four Pillars of GDMT in HFrEF.
• Slows CKD progression • Reduces risk of dialysis • Reduces albuminuria • Reduces cardiovascular events
DAPA-HF: • Reduced HF hospitalization • Reduced cardiovascular death
DELIVER: • Benefit in HFpEF
DAPA-CKD: • Slowed CKD progression • Reduced renal failure
Common:
• Genital mycotic infections • Polyuria • Hypotension • Volume depletion
Serious (rare):
• Euglycemic diabetic ketoacidosis • Fournier gangrene
• Type 1 diabetes (DKA risk) • Severe dehydration • Advanced renal failure (threshold varies by indication)
Hold during:
• Acute illness • Major surgery • Prolonged fasting
Empagliflozin: • Similar HF and CKD benefit
Sotagliflozin: • Also inhibits SGLT1 • Broader GI glucose effect
All SGLT2 inhibitors provide:
• Heart failure benefit • Renal protection • Modest glucose lowering
✔ Reduces HF hospitalization ✔ Works