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Forxiga – Uses, Mechanism of Action & Side Effects
Forxiga is a prescription medication containing the active ingredient dapagliflozin, used to treat type 2 diabetes, heart failure, and chronic kidney disease.
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Forxiga is a prescription medication containing the active ingredient dapagliflozin, used to treat type 2 diabetes, heart failure, and chronic kidney disease.
What is Forxiga?
Forxiga is a prescription medicine containing the active ingredient dapagliflozin. It belongs to a class of drugs known as SGLT-2 inhibitors (sodium-glucose cotransporter-2 inhibitors) and is used to treat type 2 diabetes mellitus, heart failure, and chronic kidney disease (CKD). Forxiga is manufactured by AstraZeneca and is approved by the European Medicines Agency (EMA) as well as other regulatory authorities worldwide.
Indications
Forxiga is approved for the following conditions:
- Type 2 diabetes mellitus: To improve blood sugar control in adults, alongside diet and exercise, either alone or in combination with other antidiabetic medications.
- Heart failure: For the treatment of symptomatic chronic heart failure with reduced or preserved ejection fraction in adults.
- Chronic kidney disease (CKD): To slow the progression of chronic kidney disease in adults.
Mechanism of Action
Dapagliflozin, the active ingredient in Forxiga, selectively inhibits the sodium-glucose cotransporter 2 (SGLT-2) in the kidneys. Under normal circumstances, this transporter reabsorbs glucose from the filtered urine back into the bloodstream. By blocking SGLT-2, dapagliflozin allows excess glucose to be excreted in the urine, thereby lowering blood sugar levels.
Beyond blood sugar reduction, dapagliflozin provides additional benefits:
- Weight reduction through increased caloric excretion via urine
- Blood pressure lowering through increased sodium and water excretion
- Cardiac unloading by reducing preload and afterload on the heart
- Kidney protection by reducing intraglomerular pressure
Dosage
The recommended dose of Forxiga is generally 10 mg once daily, taken orally regardless of meals. In some patients, particularly for blood sugar control in type 2 diabetes, treatment may be initiated at 5 mg once daily. The exact dosage is determined individually by the treating physician.
Side Effects
Like all medicines, Forxiga can cause side effects. The most common include:
- Common: Urinary tract infections, genital yeast infections (especially in women), increased urination, back pain
- Uncommon: Hypoglycemia (low blood sugar, especially when combined with insulin or sulfonylureas), dizziness, skin rash
- Rare: Diabetic ketoacidosis (a rare but serious build-up of ketone bodies in the blood), Fournier gangrene (a rare severe infection of the genital area)
Patients should seek immediate medical attention if they experience signs of ketoacidosis, such as nausea, vomiting, abdominal pain, excessive thirst, or difficulty breathing.
Contraindications
Forxiga should not be used in patients who have:
- Known hypersensitivity to dapagliflozin or any of the excipients
- Severe renal impairment (eGFR below 25 ml/min/1.73 m² for the CKD indication; not recommended for blood sugar control if eGFR is below 45 ml/min/1.73 m²)
- Type 1 diabetes
- Pregnancy or breastfeeding
Drug Interactions
Forxiga may interact with other medications. Key interactions to be aware of include:
- Combination with insulin or sulfonylureas: increased risk of hypoglycemia
- Combination with diuretics: increased risk of dehydration and low blood pressure
- Combination with lithium: dapagliflozin may affect lithium levels in the blood
Patients should always inform their doctor or pharmacist about all medications they are taking.
References
- European Medicines Agency (EMA): Forxiga (dapagliflozin) - Summary of Product Characteristics. Available at: https://www.ema.europa.eu
- Wiviott SD et al. - Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes (DECLARE-TIMI 58). New England Journal of Medicine, 2019; 380:347-357.
- Heerspink HJL et al. - Dapagliflozin in Patients with Chronic Kidney Disease (DAPA-CKD). New England Journal of Medicine, 2020; 383:1436-1446.
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