Forxiga: Advanced SGLT2 Inhibitor for Glycemic Control and Cardiovascular Protection
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Synonyms | |||
Forxiga (dapagliflozin) is a once-daily, oral medication belonging to the sodium-glucose cotransporter 2 (SGLT2) inhibitor class, specifically engineered to manage type 2 diabetes mellitus by promoting urinary glucose excretion. Its mechanism offers a non-insulin dependent pathway for lowering blood glucose, with the added advantage of cardiovascular and renal risk reduction in indicated patient populations. Supported by extensive clinical trials, Forxiga represents a paradigm shift in diabetes management, integrating metabolic control with organ protection. It is prescribed as part of a comprehensive treatment plan that includes diet and exercise.
Features
- Active ingredient: Dapagliflozin
- Available in 5 mg and 10 mg film-coated tablets
- Once-daily dosing, with or without food
- Selective and reversible inhibition of SGLT2 in the proximal renal tubules
- Promotes excretion of approximately 70–90 g of glucose per day
- Indicated for type 2 diabetes, heart failure, and chronic kidney disease (subject to regional approvals)
- Manufactured under stringent Good Manufacturing Practice (GMP) standards
Benefits
- Effective reduction of HbA1c by promoting glucosuria, independent of insulin secretion
- Associated with weight loss due to caloric loss via urine
- Demonstrates blood pressure-lowering effects through mild diuresis and natriuresis
- Proven cardiovascular benefits, including reduction in risk of hospitalization for heart failure
- Renal protective effects, slowing progression of kidney disease in patients with type 2 diabetes
- Low risk of hypoglycemia when used as monotherapy
Common use
Forxiga is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is also approved for reducing the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure (with reduced or preserved ejection fraction), and for reducing the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease. It may be used as monotherapy or in combination with other glucose-lowering agents, including insulin.
Dosage and direction
The recommended starting dose is 5 mg or 10 mg orally once daily, taken with or without food. Dosage may be adjusted based on therapeutic response and tolerability. For heart failure and chronic kidney disease, the recommended dose is 10 mg once daily. Renal function should be assessed before initiation and periodically during treatment. Tablets should be swallowed whole with water; they should not be split, crushed, or chewed.
Precautions
- Assess renal function before initiation and periodically thereafter. Not recommended in patients with eGFR <25 mL/min/1.73 m² for diabetes; use is contraindicated in patients on dialysis.
- Monitor for signs and symptoms of volume depletion, particularly in elderly patients, those on diuretics, or with renal impairment.
- Increased risk of genital mycotic infections; maintain good hygiene and monitor for symptoms.
- Rare cases of necrotizing fasciitis of the perineum (Fournier’s gangrene) have been reported; discontinue if suspected.
- Ketoacidosis has been reported in patients with type 1 and type 2 diabetes; assess risk factors and educate patients on symptoms.
- Monitor for hypersensitivity reactions.
Contraindications
- History of serious hypersensitivity to dapagliflozin or any excipients.
- Patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.
- Severe renal impairment (eGFR <25 mL/min/1.73 m²), end-stage renal disease, or patients on dialysis (for glycemic control indication).
- Concomitant use with other SGLT2 inhibitors is not recommended.
Possible side effects
Common adverse reactions (≥5%) include:
- Genital mycotic infections
- Urinary tract infections
- Increased urination
- Back pain
- Nausea
Serious but less common side effects may include:
- Ketoacidosis
- Volume depletion
- Acute kidney injury
- Necrotizing fasciitis of the perineum
- Hypersensitivity reactions
- Bone fractures (observed in clinical trials)
Drug interaction
- Diuretics: May enhance the risk of volume depletion.
- Insulin or insulin secretagogues: May increase the risk of hypoglycemia; dose adjustment may be required.
- Drugs that reduce renal function or cause volume depletion (e.g., NSAIDs, ACE inhibitors) may increase risk of acute kidney injury.
- No clinically significant interactions with metformin, sitagliptin, glimepiride, or simvastatin were observed.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time of the next dose, skip the missed dose and resume the regular dosing schedule. Do not take a double dose to make up for a missed one.
Overdose
In the event of overdose, supportive measures are recommended based on symptoms, such as correction of dehydration and hypoglycemia if present. Dapagliflozin is expected to be cleared by hemodialysis (removal of approximately 30% over 4 hours).
Storage
Store at room temperature (15–30°C or 59–86°F). Keep in the original blister pack to protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for healthcare professionals and educated patients and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations. Dosage, indications, and safety information may vary by region; refer to local prescribing information.
Reviews
Forxiga has been evaluated in multiple large-scale, randomized controlled trials (e.g., DECLARE-TIMI 58, DAPA-HF, DAPA-CKD), demonstrating significant benefits in glycemic control, cardiovascular risk reduction, and renal protection. It is endorsed by international guidelines including those from the ADA and ESC. Clinical feedback highlights its efficacy and tolerability, though monitoring for volume-related and infectious adverse events is emphasized. Patient-reported outcomes often note improved quality of life due to weight loss and reduced hypoglycemia risk.