Forxiga

Forxiga (dapagliflozin) is a once-daily oral medication indicated for the management of type 2 diabetes mellitus in adults. As a sodium-glucose cotransporter 2 (SGLT2) inhibitor, it offers a unique, insulin-independent mechanism of action by promoting the excretion of excess glucose through the urine. This approach not only helps lower blood sugar levels but is also associated with additional benefits such as weight reduction and blood pressure lowering. It is used as an adjunct to diet and exercise, and may be prescribed as monotherapy or in combination with other antidiabetic agents, including insulin, when glycemic targets are not achieved. Forxiga represents a significant advancement in diabetes care, focusing on both efficacy and cardiovascular risk reduction in appropriate patients.

Features

• Active ingredient: dapagliflozin
• Drug class: sodium-glucose cotransporter 2 (SGLT2) inhibitor
• Administration: oral tablet
• Available strengths: 5 mg and 10 mg
• Dosing frequency: once daily
• Prescription status: prescription-only medication
• Mechanism: inhibits SGLT2 in the proximal renal tubules, reducing glucose reabsorption

Benefits

• Effective reduction of HbA1c levels through insulin-independent action
• Promotes weight loss rather than weight gain commonly seen with other antidiabetic therapies
• Demonstrates blood pressure-lowering effects through mild diuresis
• Associated with reduced risk of hospitalization for heart failure in patients with type 2 diabetes and established cardiovascular disease
• Low risk of hypoglycemia when used without insulin or insulin secretagogues
• Convenient once-daily dosing supports medication adherence

Common use

Forxiga is primarily used in the management of type 2 diabetes mellitus in adults. It is indicated as an adjunct to diet and exercise to improve glycemic control. The medication may be used as monotherapy in patients for whom metformin is inappropriate due to intolerance or contraindications, or as add-on therapy in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycemic control. Forxiga has also received approval for use in heart failure with reduced ejection fraction and chronic kidney disease in specific patient populations.

Dosage and direction

The recommended starting dose of Forxiga is 5 mg once daily, taken orally in the morning, with or without food. Based on glycemic response and tolerability, the dose may be increased to 10 mg once daily. For patients with volume depletion, correcting this condition before initiating treatment is recommended. The tablet should be swallowed whole with a glass of water. Renal function should be assessed before initiation and periodically during treatment. Not recommended for use in patients with an eGFR less than 25 mL/min/1.73 m² for diabetes indication, or less than 25 mL/min/1.73 m² for heart failure and chronic kidney disease indications.

Precautions

Before initiating Forxiga, assess renal function and volume status. Monitor for signs and symptoms of volume depletion, particularly in elderly patients, those on diuretics, or with low systolic blood pressure. Consider temporary discontinuation during periods of reduced oral intake. Monitor for genital mycotic infections and symptoms of urinary tract infections. Assess for history of ketoacidosis risk factors. Not recommended during the second and third trimesters of pregnancy. Use with caution in patients with history of pancreatitis. Regularly monitor blood glucose levels and renal function during treatment. Educate patients about the symptoms of diabetic ketoacidosis.

Contraindications

Forxiga is contraindicated in patients with hypersensitivity to dapagliflozin or any excipients. It should not be used for treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Contraindicated in patients with severe renal impairment (eGFR less than 25 mL/min/1.73 m²) for diabetes treatment, end-stage renal disease, or patients on dialysis. Not recommended during the second and third trimesters of pregnancy. Should not be used in patients with history of serious hypersensitivity reaction to previous SGLT2 inhibitor therapy.

Possible side effects

Common adverse reactions (≥1/100 to <1/10) include genital mycotic infections, urinary tract infections, and volume depletion-related events such as dizziness or orthostatic hypotension. Uncommon side effects (≥1/1,000 to <1/100) may include constipation, thirst, rash, and back pain. Rare but serious adverse reactions include diabetic ketoacidosis, Fournier’s gangrene, necrotizing fasciitis of the perineum, acute kidney injury, and hypersensitivity reactions including urticaria. Cases of bone fracture have been observed in clinical trials. Laboratory abnormalities may include increases in hematocrit, LDL cholesterol, and serum creatinine.

Drug interaction

No clinically significant pharmacokinetic interactions have been observed with metformin, glimepiride, pioglitazone, sitagliptin, warfarin, digoxin, or simvastatin. However, coadministration with diuretics may increase the risk of volume depletion. Insulin and insulin secretagogues may increase the risk of hypoglycemia, requiring dose adjustment of these medications. Inducers of UGT1A9 may decrease dapagliflozin exposure. Monitor patients when coadministering with medications that may cause volume depletion or affect renal function.

Missed dose

If a dose of Forxiga is missed, it should be taken as soon as remembered on the same day. If the missed dose is not remembered until the next day, the missed dose should be skipped and the regular dosing schedule resumed. Do not take a double dose to make up for a missed dose. Maintain regular dosing schedule to ensure consistent glycemic control.

Overdose

In the event of overdose, symptomatic and supportive treatment is recommended. Dapagliflozin and its metabolites are expected to be dialyzable. In clinical studies, doses up to 100 mg (10 times the maximum recommended dose) were administered and were well tolerated. However, cases of overdose may potentially lead to dehydration, hypotension, and hypoglycemia if taken with other antidiabetic medications. Monitor vital signs, fluid status, and blood glucose levels. Contact poison control center for latest guidance.

Storage

Store Forxiga tablets at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container to protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly dispose of any unused medication according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Forxiga is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual patient responses may vary. Always follow your healthcare provider’s instructions regarding dosage and administration. Report any adverse effects to your healthcare provider promptly. The full prescribing information should be consulted before initiating therapy.

Reviews

Clinical trials demonstrate that Forxiga significantly reduces HbA1c levels by approximately 0.5-0.9% when used as monotherapy or in combination with other antidiabetic agents. The DECLARE-TIMI 58 trial showed a 17% reduction in cardiovascular death or hospitalization for heart failure in patients with type 2 diabetes and established cardiovascular disease or multiple risk factors. Real-world evidence studies support the efficacy and safety profile observed in clinical trials, with particular emphasis on its cardiovascular and renal benefits. Patient-reported outcomes indicate satisfaction with once-daily dosing and weight loss benefits, though some report increased frequency of genital infections. Overall, Forxiga is considered an important therapeutic option in the management of type 2 diabetes, particularly for patients with cardiovascular risk factors.