Forxiga (Dapagliflozin)

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What Is Forxiga?

Forxiga is an oral SGLT-2 (sodium-glucose co-transporter-2) inhibitor containing dapagliflozin (5 mg or 10 mg), manufactured by AstraZeneca. Available in packs of 28, 56 or 84 tablets. It is approved for:

• Type 2 diabetes — for glycaemic control, usually as add-on to metformin or as second line
• Heart failure — in both reduced (HFrEF) and preserved (HFpEF) ejection fraction, regardless of diabetes
• Chronic kidney disease — to slow progression, with or without diabetes

dapagliflozin was first approved 2012 (originator brand: Forxiga in EU / Farxiga in US, AstraZeneca). It is one of the most clinically important classes of antidiabetic in the last decade, because the same drug treats three of the most common long-term complications of diabetes simultaneously.

How Does Forxiga Work?

Healthy kidneys filter 180 g of glucose per day through the glomeruli and reabsorb almost all of it back into the bloodstream via the SGLT-2 transporter in the proximal tubule. In diabetes, this reabsorption is actually up-regulated — the body holds on to more glucose precisely when it should be letting some go.

dapagliflozin selectively blocks SGLT-2, causing 70–90 g of glucose per day to be excreted in urine. This:

• Lowers blood glucose by about 30–50 mg/dL — independent of insulin
• Reduces weight by 2–3 kg — urinary glucose loss equals ~280–320 kcal/day
• Reduces systolic blood pressure by 3–5 mmHg — partly osmotic diuresis, partly other pathways
• Reduces intraglomerular pressure — slowing CKD progression
• Improves cardiac energy metabolism — contributing to heart-failure benefits

Cardiovascular, Heart Failure, and Kidney Benefits

dapagliflozin has an unusually strong outcome-trial dataset:

• DECLARE-TIMI 58 (2019) — reduced the composite of cardiovascular death or heart-failure hospitalisation; MACE was non-inferior.
• DAPA-HF (2019) — 26% reduction in worsening heart failure or cardiovascular death in HFrEF patients, regardless of diabetes status. DELIVER (2022) extended the benefit to HFpEF.
• DAPA-CKD (2020) — 39% reduction in progression of CKD, stopped early for efficacy. Benefit in CKD with or without type 2 diabetes.

These trials changed practice: SGLT-2 inhibitors are now recommended for any patient with type 2 diabetes who has established cardiovascular disease, heart failure, or CKD — regardless of HbA1c.

Dosering en toediening

Standaard dosering: 10 mg once daily in the morning, with or without food. A 5 mg strength is available for some patients. For heart failure or CKD indications: 10 mg/day.

• Once-daily dosing; timing can be fixed to a routine.
• No need to take with food (unless noted for canagliflozin).
• Miss a dose — take it if remembered within 12 hours; otherwise skip.
• Forxiga/dapagliflozin: initiation allowed down to eGFR 25 mL/min/1.73 m² for heart failure/CKD indications; continue until dialysis. For diabetes glycaemic control, efficacy declines below eGFR 45.
• Do not initiate during acute illness with dehydration (risk of AKI and euglycaemic DKA).
• Sick-day rules: pause the SGLT-2 inhibitor during any acute illness with vomiting, diarrhoea, or reduced oral intake. Restart when eating normally.

Bijwerkingen

Vaak voorkomend:

• Genital mycotic infections (thrush) — up to 10% of users, mostly women. Easily treated with antifungals.
• Urinary tract infections — modest excess; most are simple cystitis.
• Increased urination (polyuria), mild dehydration, dizziness on standing (postural hypotension) — especially in the first 2 weeks.
• Modest LDL-cholesterol rise (usually < 0.2 mmol/L).

Zeldzaam maar belangrijk:

• Diabetic ketoacidosis (DKA) — rare (< 0.1% per year) but can occur at near-normal blood glucose (“euglycaemic DKA”). Risk factors: reduced carbohydrate intake, acute illness, surgery, insulin dose reduction. Symptoms: nausea, vomiting, abdominal pain, deep breathing. Stop the drug and seek urgent care.
• Volume depletion — higher risk in older adults, those on diuretics, or low baseline blood pressure.
• Acute kidney injury — usually pre-renal in setting of dehydration; reversible when drug is held.
• Fournier’s gangrene — extremely rare necrotising perineal infection; medical emergency.
• No amputation signal.

Geneesmiddelinteracties

• Diuretics (especially loop and thiazide) — additive volume loss; consider reducing diuretic dose when starting.
• Insuline en sulfonylureumderivaten — additive glucose-lowering; those doses may need reducing to avoid hypoglycaemia.
• Lithium — increased urinary loss can raise lithium levels.
• Rifampicine — reduces SGLT-2 inhibitor levels; a larger dose may be needed.
• Antihypertensiva — additive BP-lowering; monitor for dizziness.

Who Should Not Take Forxiga?

• Type 1 diabetes mellitus (unless off-label and specialist-supervised)
• Diabetic ketoacidosis — current or recent history
• Severe renal impairment below the initiation cutoff
• End-stage renal disease on dialysis (stop once on dialysis for empagliflozin; dapagliflozin may be continued per some protocols)
• Severe volume depletion or hypotension
• Pregnancy and breastfeeding — limited data; avoid
• Known hypersensitivity to SGLT-2 inhibitors
• Canagliflozin: prior lower-limb amputation or active foot ulcer (relative)

Opslag

Store Forxiga below 30°C in a dry place, in the original blister. Keep out of reach of children.

Veelgestelde vragen

Is Forxiga the same as dapagliflozin?

Yes — Forxiga contains dapagliflozin as the active ingredient. Bioequivalence is required by regulatory authorities, so clinical effect is the same at the same dose.

Is dapagliflozin the same as Jardiance?

No — they are two different SGLT-2 inhibitors with similar class effects. Dapagliflozin (Forxiga) has DAPA-HF and DAPA-CKD trial data; empagliflozin (Jardiance) has EMPA-REG, EMPEROR, and EMPA-KIDNEY. Both are approved for type 2 diabetes, heart failure (including HFpEF), and chronic kidney disease. For most patients, the choice comes down to availability, cost, and prescriber preference.

Will Forxiga help me lose weight?

Yes, modestly — typically 2–3 kg loss over 6–12 months. The weight loss is because your kidneys excrete 70–90 g of glucose (~280–320 kcal) per day in urine. It is real but limited — do not expect the dramatic effects seen with GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro).

Will Forxiga lower my blood pressure?

Yes — expect about 3–5 mmHg systolic fall systolic fall. If you are already on blood-pressure medicines and close to target, you may need a dose reduction when starting Forxiga to avoid dizziness.

Can Forxiga cause thrush or UTIs?

Yes — genital thrush is the most common side effect (up to 10% of users, mostly women). It is usually mild and easily treated with topical or oral antifungals. Urinary tract infections are modestly more common but usually simple. Good hygiene helps; most patients do not need to stop the drug.

Can I take Forxiga if my kidneys are not great?

Yes — and in fact, SGLT-2 inhibitors protect the kidneys in CKD. Initiation cutoffs differ by molecule (check renal dosing section), but once started they are typically continued down to dialysis because the kidney-protective effect persists even when the glucose-lowering effect has faded.

What do I do on sick days or before surgery?

Hold Forxiga during any acute illness with dehydration, vomiting, or reduced oral intake, and during major surgery or fasting. This reduces the risk of euglycaemic DKA and acute kidney injury. Restart once eating and drinking normally.

Where can I buy Forxiga online?

You can order Forxiga (5 mg or 10 mg) from MedsBase in packs of 28, 56 or 84 tablets. We ship worldwide, with discreet packaging and genuine WHO-GMP certified manufacturer stock.

Gerelateerde diabetesmedicatie

• Jardiance — Empagliflozin 25 mg (Boehringer)
• Forxiga — Dapagliflozin 5/10 mg (AstraZeneca)
• Invokana — Canagliflozin 100 mg (Janssen)
• Glyxambi — Empagliflozin + Linagliptin combo
• Januvia — Sitagliptin (DPP-4 alternative)
• Glycomet SR — Metformine met vertraagde afgifte
• Bekijk alle diabetesmedicatie

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