Dapagliflozin is the first among the SGLT-2 inhibitors that was marketed in Pakistan. Internationally, Forxiga is the brand leader. It prevents the reabsorption of glucose from the renal tubules resulting in glucosuria (glucose lost in urine). Another SGLT-2 inhibitor commonly being used in Pakistan is empagliflozin. Dapagliflozin is available is a single drug and in combination with metformin. It has also been approved by the European Union in obese patients with type 1 diabetes mellitus and uncontrolled blood sugars. However, the FDA has opposed its approval because of the risk of diabetic ketoacidosis and limited evidence in favor of its use. It should also be avoided in patients with kidney disease and pregnant patients.

The dose of dapagliflozin:

In Pakistan, dapagliflozin tablets come in strengths of 5 and 10 mg. It should be taken once day at a dose of 5 mg, with the potential to increase it to 10 mg.

Common side effects of dapagliflozin:

Side effects of dapagliflozin include:

• nausea and dyspepsia,

• polyuria, dysuria

• urinary tract infections

• hypovolemia

• dehydration

• acute kidney injury

• syncope

• flu and pharyngitis

• dyslipidemias

• backpain

• allergic reactions

SGLT-2 inhibitors and canagliflozin, in particular, have been associated with an increased incidence of bone fractures. Urogenital infections can be very bothersome especially in females. These include vaginal candidiasis and recurrent urinary tract infections. Life-threatening infection of the genital area - the Fournier gangrene has recently been associated with its use. Patients with unstable kidney functions should not be advised dapagliflozin or other SGLT-2 inhibitors because of the risks of acute kidney injury as a result of volume depletion. Dyslipidemia is another serious side effect of dapagliflozin and other SGLT-2 inhibitors. It may cause an elevation in the LDL cholesterol that may require treatment with a statin. Another serious complication of dapagliflozin is euglycemic ketoacidosis. The risk is high in patients who require insulin, have stopped insulin, alcoholics, caloric restriction, strenuous activity, and patients who have a recent stroke, myocardial infarction, surgery, or other kinds of stress.

When should you take dapagliflozin?

It should be taken orally, preferably in the early morning after breakfast.

Dapagliflozin tablet brand names in Pakistan:

Although dapagliflozin is a relatively new drug, the list of dapagliflozin brands in Pakistan is getting longer. Some of the important brands of dapagliflozin are listed here.

• Dapa 5 mg and 10 mg (Hilton Pharma)
• Xiga 5 mg and 10 mg (CCL Pharma)
• Dapaglu 5 mg and 10 mg (Scotmann Pharma)
• Forziga 5 mg and 10 mg (Mcolson Pharma)

Dapagliflozin metformin brand names in Pakistan:

• Dapa-Met 5/850 mg and 5/1000 mg (Hilton Pharma)