Dapagliflozin is a medicine is mainly used to treat type 2 diabetes. Sometimes it can be used together with insulin to treat type 1 diabetes.

Dapagliflozin is usually prescribed for type 2 diabetes if you cannot take metformin.

It can also be taken together with other diabetes medicines when a single medicine is not controlling your blood sugar properly.

If you’re overweight and have type 1 diabetes, your diabetes specialist may prescribe dapagliflozin if high doses of insulin aren’t controlling your blood sugar. This will be under careful supervision.

Dapagliflozin is only available on prescription and it comes as tablets.

• Dapagliflozin works on your kidneys. It increases the amount of sugar removed from your body when you pee.
• If you're taking dapaglifozin with other diabetes medicines, it can sometimes cause low blood sugar (hypoglycaemia). It's a good idea to carry some sweets or fruit juice with you in case this happens.
• Unlike some diabetes medicines, dapagliflozin does not make you put on weight. In fact, some people find they lose weight.
• For type 1 diabetes, always carry your alert card to say you’re taking dapagliflozin. It increases the risk of diabetic ketoacidosis (DKA).
• Dapagliflozin can be called by the brand name Forxiga.
• Dapagliflozin also comes combined with other diabetes medicines. Brand names include Xigduo (dapagliflozin with metformin) and Qtern (dapagliflozin with saxagliptin).

Dapagliflozin can be taken by adults.

Dapagliflozin is not suitable for some people. Tell your doctor before starting the medicine if you:

• have had an allergic reaction to dapagliflozin or any other medicines in the past
• have sugar (glucose) and ketones (a type of chemical) in your pee - there are home tests for this
• have severe kidney or liver disease
• have a heart condition
• often get urinary tract infections (UTIs)
• are due to have surgery
• are pregnant, trying to get pregnant or breastfeeding

It's usual to take dapagliflozin once a day. You can take it any time of day - just try to take it at the same time every day.

Dapagliflozin can be taken with or without food.

Swallow the tablets whole with a glass of water. Do not chew them.

How much will I take?

For type 2 diabetes, the usual dose of dapagliflozin is 10mg, taken once a day. Your doctor may start you off on a lower dose of 5mg.

If you're taking a combination tablet (dapagliflozin with metformin or dapagliflozin with saxagliptin), the doses may vary.

For type 1 diabetes, the usual dose is 5mg, taken once a day. You’ll take this as well as your insulin.

Taking dapagliflozin with metformin (Xigduo)

There are 2 different strengths of Xigduon. Each tablet contains 5mg of dapagliflozin and the amount of metformin is either 850mg or 1g.

Your doctor will prescribe the strength with the right amount of metformin for you.

The usual dose is 1 tablet taken twice a day. It's a good idea to take your medicine with a meal. This means the metformin is less likely to affect your stomach.

Taking dapagliflozin with saxagliptin (Qtern)

There's only 1 strength of Qtern - each tablet contains 10mg of dapagliflozin and 5mg of saxagliptin.

The usual dose is 1 tablet taken once a day. You can take it any time of day - just try to take it at the same time every day.

Qtern can be taken with or without food. Swallow the tablets whole with a glass of water. Do not chew them.

What if I forget to take it?

Dapagliflozin, or dapagliflozin with saxagliptin (Qtern)

If you miss a dose of dapagliflozin or Qtern and it's 12 hours or more until your next dose, take it as soon as you remember. Then take your next dose at the usual time.

If it's less than 12 hours until your next dose, skip the missed dose. Then take your next dose at the usual time.

Dapagliflozin with metformin (Xigduo)

If you miss a dose of Xigduo, take it as soon as you remember, unless it's nearly time for your next dose, in which case skip the missed dose and take your next dose at the usual time.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too many dapagliflozin tablets, contact your doctor straight away. An overdose of dapagliflozin can cause low blood sugar.

If you think you have low blood sugar, have some food or drink that quickly gets sugar into your bloodstream (like sugar cubes or fruit juice).

This type of sugar will not stay in your blood for long. You may also need to eat a starchy carbohydrate, like a sandwich or a couple of biscuits.

Like all medicines, dapagliflozin can cause side effects, although not everyone gets them.

Side effects often improve as your body gets used to the medicine.

Diabetic ketoacidosis (DKA) can be a common side effect for people taking dapagliflozin for type 1 diabetes. DKA is a serious condition.

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and short-lived.

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

• thrush
• back pain
• peeing more than normal
• feeling dizzy
• mild skin rash

Diabetic ketoacidosis (DKA)

If you have type 1 diabetes and you’re taking dapagliflozin, you’re at increased risk of getting DKA.

You’ll be shown how to monitor your ketone and blood sugar levels, and what to do if you have a “sick day”. You’ll learn how to recognise the symptoms of DKA and what to do about it.

You will also get an alert card. Show this to any health professionals involved in your care.

Other serious side effects

Apart from DKA for people with type 1 diabetes, serious side effects are rare and happen in less than 1 in 10,000 people.

Tell your doctor or go to A&E straight away if:

• you're feeling or being sick, feel very thirsty, confused or unusually tired, have stomach pain, your breath smells fruity, and your breathing is deep or fast – these can be signs of diabetic ketoacidosis, which can also happen in people with type 2 diabetes. Symptoms usually develop over 24 hours, but can come on faster
• you have a very dry or sticky mouth, feel very thirsty, sleepy or tired, are not peeing (or peeing very little), and have a fast heart beat – these can be signs of dehydration
• you have a high temperature or feel cold and shivery, get a burning feeling when peeing, have pain in your back or side, or blood in your urine – these can be signs of a urinary tract infection (UTI)
• your genital area is painful, sore, red or swollen and you have a high temperature or feel unwell - these can be signs of gangrene

Low blood sugar

If you take dapagliflozin with other diabetes medicines, including insulin or sulphonylureas like gliclazide, your blood sugar can sometimes go too low.

This is called hypoglycaemia or a "hypo".

Early warning signs of low blood sugar include:

• feeling hungry
• trembling or shaking
• sweating
• confusion
• difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep.

If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar may happen if you:

• take too much of some types of diabetes medicines
• eat meals irregularly or skip meals
• are fasting
• do not eat a healthy diet and are not getting enough nutrients
• change what you eat
• increase your physical activity without eating more to compensate
• drink alcohol, especially after skipping a meal
• take some other medicines or herbal medicines at the same time
• have a hormone disorder, such as an underactive thyroid (hypothyroidism)
• have kidney or liver problems

It's important to have regular meals, including breakfast, to prevent hypoglycaemia. Never miss or delay a meal.

If you're planning to exercise more than usual, make sure you eat carbohydrates like bread, pasta or cereals before, during or after exercise.

Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.

You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

If taking in sugar does not help or the hypo symptoms come back, contact your doctor or the nearest hospital.

Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to dapagliflozin.

These are not all the side effects of dapagliflozin. For a full list, see the leaflet inside your medicines packet.

What to do about:

• thrush – ask your pharmacist to recommend an antifungal treatment for thrush. Speak to your doctor if it does not work within a week or you get thrush often. There are also things you can do to prevent thrush returning.
• back pain – if you get sudden unexpected back pain, do not try to treat it yourself. Contact your doctor - it might be a sign of a urinary tract infection (UTI).
• peeing more than normal – this is a sign that you're peeing out more sugar in your urine. If this side effect bothers you, talk to your doctor or pharmacist.
• feeling dizzy – if dapagliflozin makes you feel dizzy, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machines if you feel dizzy or shaky.
• mild skin rash – it may help to take an antihistamine. Check with a pharmacist to see what type is suitable for you. Speak to your doctor if the rash does not go away or gets worse.

Dapagliflozin is generally not recommended during pregnancy or while breastfeeding. We do not know whether dapagliflozin can harm an unborn baby.

For safety, your doctor will probably change your medicine to insulin if you're trying for a baby or as soon as you find out you're pregnant.

Dapagliflozin and breastfeeding

It's generally not recommended to take dapagliflozin while breastfeeding.

We do not know for certain whether dapagliflozin gets into breast milk. But it's possible that dapagliflozin can affect the way babies' kidneys develop and grow.

Speak to your doctor about what's best for you and your baby. They may prescribe a different medicine, particularly while you're breastfeeding a newborn or premature baby.

There are some medicines that may increase the effects of dapagliflozin.

This can make you more likely to get side effects.

Tell your doctor if you're taking any of these medicines before you start taking dapagliflozin:

• medicines that make you pee more (diuretics), like furosemide - these can increase your risk of dehydration and lower your blood pressure
• high blood pressure medicine
• other medicines that can lower your blood pressure - including some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), tamsulosin (for an enlarged prostate), or co-careldopa or levodopa (for Parkinson's disease)
• medicines that cause low blood sugar, such as insulin or gliclazide - your doctor may lower your dose of these other medicines to prevent hypos

Mixing dapagliflozin with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with dapagliflozin.