Not indicated for patients w/ type 1 diabetes. Not to be used for diabetic ketoacidosis. Patients for whom a dapagliflozin-induced BP drop (eg, those w/ known CV disease, on antihypertensive therapy w/ history of hypotension or elderly) pose a risk. Carefully monitor vol status & electrolytes; consider temporary interruption for patients who develop vol depletion. Patients w/ predisposing factors to ketoacidosis [eg, low β-cell function reserve resulting from pancreatic disorders (eg, type 1 diabetes, history of pancreatitis or pancreatic surgery), insulin dose reduction, reduced caloric intake or increased insulin requirements due to infections, illness, surgery & alcohol abuse]. Assess for signs & symptoms consistent w/ ketoacidosis including nausea, vomiting, abdominal pain, malaise & shortness of breath even if blood glucose levels are <14 mmol/L. Consider discontinuation or temporary interruption if ketoacidosis is suspected & promptly evaluate patient. Interrupt treatment in patients who are hospitalized for major surgical procedures or acute serious medical illnesses. Discontinue use if Fournier's gangrene is suspected & institute prompt treatment. Hypoglycemia w/ insulin & insulin secretagogues (eg, sulfonylureas). Not recommended to initiate in patients w/ GFR <25 mL/min; may continue 10 mg once daily to reduce risk of eGFR decline, ESRD & CV death. Reduced glucose-lowering efficacy in patients w/ eGFR <45 mL/min/1.73 m
2. Not to be used in patients w/ severe hepatic impairment. Not to be used in 2nd & 3rd trimester of pregnancy; discontinue use if pregnancy is detected. Not to be used by a nursing woman. Childn & adolescent. Elderly.
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