Management of Dapagliflozin in Patients with Urinary Tract Infections
Rationale for Holding Dapagliflozin
- The European Association of Urology recommends managing underlying complicating factors as a strong recommendation for complicated UTI treatment, and dapagliflozin-induced glucosuria represents a modifiable complicating factor 1, 2, 3
- For complicated UTIs, empirical treatment should include combination therapy with aminoglycosides plus beta-lactams or third-generation cephalosporins, with treatment duration of 7-14 days 1, 3
Clinical Decision Algorithm
- Hold dapagliflozin if a patient has a symptomatic UTI with systemic symptoms, complicated UTI, pyelonephritis or upper tract involvement, as recommended by the European Urology guidelines 1, 2, 4, 5
- The European Urology guidelines suggest that dapagliflozin may be continued with caution in patients with uncomplicated lower UTI, mild symptoms, and no history of recurrent UTIs, with close monitoring 4, 5
UTI Management Guidelines
- The European Association of Urology 2024 guidelines emphasize the importance of addressing underlying urological abnormalities in patients with UTIs, particularly those taking dapagliflozin 1, 3
When to Resume Dapagliflozin
- Resume dapagliflozin only after complete resolution of UTI symptoms, patient is clinically stable and afebrile for at least 48 hours, completion of appropriate antibiotic course, and patient has resumed normal oral intake 4, 5, 6, 7
- The European Urology guidelines recommend addressing any underlying urological abnormalities before resuming dapagliflozin 1, 3