Dapagliflozin Clinical Guidelines

Contraindications and Precautions

The American College of Cardiology recommends that dapagliflozin is contraindicated in patients with a history of pregnancy or breastfeeding, on dialysis, or with end-stage renal disease (ESRD) 1
The American College of Cardiology advises withholding dapagliflozin at least 3 days before major surgery or procedures with prolonged fasting to prevent postoperative ketoacidosis 1
The American College of Cardiology suggests that dapagliflozin may cause intravascular volume contraction, particularly in patients with renal impairment, low systolic blood pressure, elderly patients, or those on diuretics 1, 3
The American College of Cardiology recommends assessing volume status before starting dapagliflozin and correcting volume depletion if present 2

The American College of Cardiology notes that genital mycotic infections occur in approximately 6% of patients on SGLT2 inhibitors versus 1% on placebo, and daily hygienic measures may reduce risk 2
The American College of Cardiology states that urinary tract infections are more frequent with dapagliflozin than placebo 1
The American College of Cardiology warns of the risk of euglycemic diabetic ketoacidosis, a life-threatening event that can occur with normal glucose levels 1

The American College of Cardiology recommends checking renal function by assessing eGFR before initiation, within 1-2 weeks after starting, then every 3-6 months if eGFR 45-59 mL/min/1.73 m², or annually if eGFR ≥60 mL/min/1.73 m² 2
The American College of Cardiology suggests monitoring volume status and assessing for signs of dehydration 2
The American College of Cardiology advises educating patients on recognition and prevention of signs of genital/urinary infections 2