Sodium-glucose cotransporter-2 (SGLT2) inhibitor
ATC code: A10BK01 (Dapagliflozin)
A selective reversible SGLT2 inhibitor in proximal nephron tubules. Reduces glucose reabsorption from primary urine by 30–50% and increases urinary glucose excretion by 50–80 g/day. This gives moderate reduction (0.5–0.7%), weight reduction (2–3 kg), BP reduction, and diuresis with natriuresis. Beyond glycemic effect, improves cardiovascular and renal outcomes independent of diabetes – the main modern class advantage.
First line
Foundation therapy in chronic kidney disease in adults per KDIGO 2024 to slow eGFR decline regardless of diabetes. DAPA-CKD (2020) reduced CKD progression, dialysis, transplant, or death by 39%. Minimum starting eGFR 25 mL/min. Dose 10 mg once daily.
First line
Foundation therapy in chronic HF per 2023 as one of four «fundamental» components (ARNI/ACE-I + β-blocker + aldosterone antagonist + SGLT2 inhibitor). DAPA-HF (2019) showed 26% reduction in cardiovascular death or HF hospitalization in HFrEF; DELIVER (2022) – 18% in HFpEF. Effect independent of diabetes. Dose 10 mg once daily.
Used in HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction, with or without diabetes.
First line
First-line for type 2 diabetes per / 2024 and SED 2023, on par with metformin in patients with established cardiovascular or renal disease. Dose 10 mg once daily. DECLARE-TIMI 58 (2019) showed 17% reduction in cardiovascular death or HF hospitalization and 24% reduction in renal progression in T2D patients with risk factors. Can be added to metformin, ACE-I, ARB, statins.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. It is prescribed for type 2 diabetes, heart failure (regardless of diabetes), and chronic kidney disease ( 2024, 2024, KDIGO 2024). In anti-aging and longevity communities, dapagliflozin is promoted as an mTOR-sparing metabolic modulator in non-diabetics for life extension. In people without diabetes, heart failure, or CKD, no clinical studies of prophylactic use for anti-aging exist. The drug causes urogenital infections (5-10% of cases), euglycemic diabetic ketoacidosis (rare but dangerous), and volume disturbance with fall risk in older adults. If dapagliflozin was prescribed to a person without diabetes or heart failure, consider seeking a second opinion.
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Limited pregnancy data. When pregnancy is planned in T2D patients, discontinue and switch to insulin. In pregnant HF patients, decisions are made with the cardiologist.
Limited data. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Dapagliflozin is evaluated for the following indications with varying evidence strength: Heart failure (evidence tier A), Type 2 diabetes mellitus (evidence tier A), Chronic kidney disease (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Dapagliflozin (≥ 1 in 100): Genital fungal infections (balanitis in men, vulvovaginal candidiasis in women), Urinary tract infections, Polyuria and thirst, Dyslipidemia (modest LDL rise), BP reduction and dizziness. See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. When pregnancy is planned in T2D patients, discontinue and switch to insulin. In pregnant HF patients, decisions are made with the cardiologist.
Limited data. Not used during lactation.
Dapagliflozin is contraindicated in: Dapagliflozin hypersensitivity; Type 1 diabetes (ketoacidosis risk); Diabetic ketoacidosis; Severe renal impairment (eGFR under 25); Severe dehydration. Full list in the Safety section.