Medication Information

Forxiga, known generically as dapagliflozin, is an oral medication used primarily to treat type 2 diabetes mellitus. It belongs to a class of drugs known as SGLT2 inhibitors, which work by helping the kidneys remove glucose from the bloodstream through urine.

Pharmacological Class

Forxiga is classified as an SGLT2 inhibitor. This class of drugs helps lower glucose levels in the blood by preventing the kidneys from reabsorbing glucose. This leads to the excretion of glucose through urine, thus reducing high blood sugar levels.

Mechanism of Action

Forxiga works by inhibiting the sodium-glucose co-transporter 2 (SGLT2) in the proximal convoluted tubules of the kidneys. SGLT2 is responsible for reabsorbing a significant portion of the glucose filtered by the kidneys. By blocking this transporter, Forxiga increases the excretion of glucose in urine, thereby reducing blood glucose levels.

Indications

Forxiga is indicated for the treatment of adults with type 2 diabetes mellitus to improve glycemic control, either as monotherapy or in combination with other antidiabetic agents. It can also aid in weight loss and help manage blood pressure in patients with type 2 diabetes.

Dosage and Administration

The recommended starting dose of Forxiga is 10 mg once daily, taken in the morning with or without food. Dose adjustments are not typically necessary but should be guided by renal function and patient’s response to therapy. Consult the prescribing information or a healthcare professional for further guidance.

Pharmacokinetics

Forxiga is rapidly absorbed after oral administration, reaching peak plasma concentrations within 1-2 hours. It has a bioavailability of approximately 78%. The drug undergoes extensive metabolism, primarily by the liver enzyme CYP3A4, and its elimination half-life is approximately 12 hours. It is excreted primarily in the urine.

Contraindications

Forxiga is contraindicated in patients with severe renal impairment, end-stage renal disease, or those on dialysis. It is also contraindicated in patients with a history of serious hypersensitivity reactions to dapagliflozin or any of the excipients in Forxiga tablets.

Drug Interactions

Concomitant use of Forxiga with diuretics may increase the risk of volume depletion and hypotension. Co-administration with insulin or insulin secretagogues (e.g., sulfonylureas) may increase the risk of hypoglycemia. The efficacy of Forxiga may be reduced when used with other medications that can affect renal function or glucose reabsorption mechanisms.

Adverse Reactions

Common adverse reactions associated with Forxiga use include genital mycotic infections, urinary tract infections, and increased urination. Other possible side effects include hypoglycemia, particularly when used with insulin or insulin secretagogues, as well as dehydration, hypotension, and an increased risk of amputations.

Special Populations

Renal impairment significantly affects the pharmacokinetics of Forxiga, necessitating dose adjustments or discontinuation. Forxiga is not recommended for use in patients with severe renal impairment or in end-stage renal disease. Limited data is available regarding its use in pregnant and lactating women; it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Monitoring Parameters

Patients taking Forxiga should be monitored for renal function, electrolyte levels, and signs of volume depletion. Regular blood glucose testing is also essential to ensure effective glycemic control. Liver function tests may be necessary due to the hepatic metabolism of the drug.

Patient Counseling

Patients should be informed of the potential risk of dehydration and should be advised to maintain adequate fluid intake. They should also be directed to monitor for signs of urinary tract infections and genital infections and to seek medical advice if symptoms arise. Patients should be advised on the signs of hypoglycemia and the proper steps to manage low blood sugar events.

Storage and Stability

Store Forxiga at room temperature, away from moisture and heat. Keep it in its original container and out of reach of children. Do not use the medication beyond its expiration date.