Drug Breakdown: Dapagliflozin

Day 1: In the mid 19th century, phlorizin extracted from the root bark of the apple tree was found to cause glycosuria; there was poor oral absorption and also, because non-selective, the inhibition of gut SGLT1 led to unpleasant gut side-effects. Synthesis of analogues in the 1990s led to #dapagliflozin licensed by EMA in 2012.

Day 2: Indications are for primary diabetes mellitus as monotherapy (T2DM) or in combination with insulin for T1DM or T2DM. Dose 5 mg (T1) or 10 mg (T2) once daily. #dapagliflozin is also routinely combined with other hypoglycaemic agents eg metformin. NICE TA597 (2020) outlines strict guidance for #dapagliflozin use in T1DM, including BMI ≥27kg/m² and providing education about ketoacidosis.

Day 3: #dapagliflozin has good oral absorption and bioavailability with high protein binding. Metabolised by phase 2 glucuronidation (minor CYP activity) with renal excretion of inactive metabolites-t½ 14hrs. Monitor renal function throughout & don't start if eGFR<60 60 mL/minute/1.73 m²/avoid if <45.