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Diabetes Medications and New Drugs

Dapaglifozin (Forxiga)

What is dapaglifozin?

Dapaglifozin is a new addition to the line-up of drugs used in the treatment of type 2 diabetes. It works in a completely different way to previous medications which help lower blood glucose. It is available under the name Forxiga which is the brand name given to the drug by manufacturers Bristol Myers-Squibb.

How does dapaglifozin work?

Glucose in the blood is filtered through the kidneys. Usually most of this filtered glucose is re-absorbed by the kidneys using a transport system called SGLT2. Dapaglifozin blocks this transport system. This prevents glucose from being re-absorbed and increases the amount of glucose passing via the urine.

Is it effective ?

There have been many research studies which have looked at the benefits of Forxiga in patients with type 2 diabetes. Some of these have looked at patients taking Forxiga alone whereas others have evaluated the benefit of Forxiga in combination with other blood glucose lowering medication such as metformin or sulphonylureas.

Are there any particular benefits of dapaglifozin?

The ability to lower blood glucose without significant side effects as well as reduce body weight are thought to be the main advantages of this new class of oral hypoglycaemic agents.

What is the dose of dapaglifozin?

Dapaglifozin is available in tablets of 5mg and 10mg. The recommended dose is 10mg which is taken once daily.

What are the side effects of dapaglifozin?

Studies have shown that patients taking dapaglifozin are at higher risk of developing urinary tract infection and genital infections such as candidiasis (thrush). People who have diabetes are already at increased risk of these infections. It is thought that this risk is due to the presence of glucose in the urine.

What is the risk of hypoglycaemia with dapaglifozin?

No major hypoglycaemia was observed in studies of patients taking dapaglifozin alone as treatment for type 2 diabetes.

Is there a risk of cancer with dapaglifozin?

Investigators observed a higher number of patients with bladder cancer and breast cancer within the groups treated with dapaglifozin as compared with the control groups. It is thought that it is unlikely the drug caused the tumours but it is not known if they were

Can it be safely combined with other drugs?

Yes, dapaglifozin has been used in combination with metformin and sulphonylureas.

Can dapaglifozin be safely taken with insulin?

Yes. The mode of action is independent of insulin and this drug may help counter any weight gain associated with insulin therapy.

Can dapaglifozin be combined with GLP1 drugs such as Exenatide?

This is not recommended as there have been no studies which have looked at these drugs in combination with Forxiga.

Are there any drugs which should not be combined with dapaglifozin?

It is not recommended that dapaglifozin is used in combination with Pioglitazone due to concerns with regard to the risk of bladder cancer.

Dapaglifozin causes a diuresis (increased passage of urine). It is therefore not recommended in patients taking loop diuretics which are a commonly prescribed type of 'water tablets'.

Who should take dapaglifozin?

The place of dapaglifozin in treatment is currently being evaluated by clinicians across the UK. More details will no doubt emerge with increased usage.

Is there any data on long-term cardiovascular outcomes?

At present no long term data is available surrounding the use of this new class of drugs.

Is there current NICE guidance surrounding the use of dapaglifozin?

Yes, the National Institute for Health and Clinical Excellence issued its Final Appraisal on the use of dapaglifozin on the 30th of May 2013. In brief, they recommended it's use as dual-therapy with metformin, if used as described for the DPP4 inhibitors. They also approved the use of dapaglifozin in combination with insulin. The use of triple therapy in combination with metformin and sulphonylurea however was not advocated.

What is the cost of dapaglifozin?

A months supply of dapaglifozin costs in the region of 37, regardless of the dose (5mg daily or 10mg daily).

 

Dr Nishan Wijenaike
Consultant Physician
July 2013

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Glucose Lowering drugs

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Cholesterol and other lipid lowering drugs

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Drugs for Type 2 diabetes