Dapagliflozin is a drug used in the treatment of type 2 diabetes mellitus.
Since long been in trials, it is a newer addition to the oral medications used in diabetes mellitus.
Various companies have started marketing it in Pakistan. This is a very good news for patients who have failed to control their blood sugars with oral drugs.
Another drug of the same group which has recently been lauched in Pakistan is Empagliflozin.
How does dapagliflozin work?
Dapagliflozin belongs to a group of drugs called sodium-glucose cotransporters (SGLT 2 inhibitors).
This group of drugs acts on the tubules of kidneys to excrete excess glucose from the blood in urine.
The concept of the dapagliflozin, Empagliflozin, and other similar drugs was taken from a congenital tubular defect in certain patients termed as familial glucosuria.
Patients with familial glucosuria have a defect in the channels which reabsorb glucose and so they excrete the glucose which is filtered by the kidneys.
In healthy diabetic patients, dapagliflozin blocks SGLT 2 channels responsible for reabsorbing the glucose filtered. This leads to a reduction in blood glucose.
What are the advantages and disadvantages of using dapagliflozin?
Since dapagliflozin is an oral drug, this is a new addition to the antidiabetic medications.
This drug can be combined, theoretically, with insulin in type 1 diabetes for better control.
In type 2 diabetes patients and especially who are on maximum oral drugs and not willing for insulin, dapagliflozin might save them from the needle prick.
SGLT2 Inhibitors prevent the reabsorption of glucose leading to excess glucose in urine. This is accompanied by excess water loss as well by the process of osmotic diuresis.
Loss of excess water leads to a reduction in plasma volume and thus reducing blood pressure.
This effect is similar to using diuretics. This mechanism also favors its use in patients with congestive heart failure and other conditions with fluid overload like state.
Adverse effects of dapagliflozin:
Diabetic patients are prone to infections because of the immune dysfunction in diabetic patients.
Excess glucose loss in urine because of these drugs allow bacterial overgrowth in the urogenital tract.
This leads to recurrent urinary tract infections in these patients. Urinary tract infections can at times be very problematic. SGLT2 inhibitors have also been associated with severe genital infections.
The incidence of Fournier’s gangrene or necrotizing fasciitis has markedly increased with the use of these drugs.
Fournier’s gangrene can be deadly at times. Urinary tract infections can be challenging in patients with autonomic neuropathy and those with urinary retention or catheterized patients.
Other serious adverse effects include volume depletion, increase risks of strokes, and diabetic ketoacidosis.
Patients should also be advised to maintain adequate hydration and exercise regularly.
The markets will flood with these latest group of drugs. Its the duty of the physician to prescribe the drugs cautiously.
How to take dapagliflozin?
Dapagliflozin is available as a 5 and 10 mg tablet to be taken once or twice daily, preferably after breakfast.
In conclusion …
Launching dapagliflozin in Pakistan is a great step. Patients with heart failure and those on maximum oral anti-diabetic medicines, especially those not willing for insulin, may be prescribed dapagliflozin or other medicines from the same class.
Physicians should never forget the old time-tested drugs like metformin and DPP IV inhibitors like sitagliptin and vildagliptin.
Initiation of Insulin should not be delayed if the glycemic targets are not achieved.