Meta Information
ID:dapagliflozin
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/loop-diuretics
Target name:
Loop Diuretics (e.g., Furosemide)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Both dapagliflozin and loop diuretics cause significant fluid and electrolyte loss. Their combined use greatly increases the risk of severe dehydration, low blood pressure (hypotension), and acute kidney injury.
Actionable advice:
Avoid this combination unless under strict medical supervision with close monitoring of hydration and kidney function.
Target id:
/class/antidiabetic-medications
Target name:
Insulin and Insulin Secretagogues (e.g., Sulfonylureas)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining dapagliflozin with medications that strongly stimulate insulin release or provide external insulin significantly increases the risk of dangerously low blood sugar (hypoglycemia).
Actionable advice:
Requires close glucose monitoring and a likely dose reduction of the insulin or secretagogue when starting dapagliflozin.
Target id:
/condition/renal-impairment
Target name:
Renal Impairment (Kidney Disease)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin's effectiveness and safety are dependent on kidney function. It is not recommended or is contraindicated in patients with a severely low estimated glomerular filtration rate (eGFR) as it may not work and could increase risks.
Actionable advice:
Avoid completely if your eGFR is below the recommended threshold (typically <25-30 mL/min/1.73m²).
Target id:
/intervention/ketogenic-diet
Target name:
Ketogenic Diet
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
A ketogenic diet, which promotes high ketone levels, combined with dapagliflozin significantly increases the risk of euglycemic diabetic ketoacidosis (eDKA), a life-threatening condition where the body is highly acidic despite normal blood sugar.
Actionable advice:
Avoid using dapagliflozin while following a strict ketogenic diet due to the high risk of eDKA.
Target id:
/procedure/major-surgery
Target name:
Major Surgery or Medical Procedure
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
72
Hours after target:
null
Description:
The physiological stress of surgery, combined with potential fasting and dehydration, increases the risk of euglycemic ketoacidosis (eDKA). Dapagliflozin should be temporarily discontinued.
Actionable advice:
Stop taking dapagliflozin at least 3 days before any major surgery or stressful medical procedure.
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin promotes fluid loss through urination (osmotic diuresis), which can dangerously worsen existing dehydration and increase the risk of acute kidney injury and severe low blood pressure.
Actionable advice:
Do not take dapagliflozin when acutely ill or dehydrated; rehydrate fully before resuming the medication.
Target id:
/class/sglt2-inhibitors
Target name:
Other SGLT2 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Taking more than one SGLT2 inhibitor (e.g., empagliflozin, canagliflozin) is redundant, provides no additional benefit, and significantly increases the risk of all associated side effects like dehydration, ketoacidosis, and infections.
Actionable advice:
Never combine dapagliflozin with another medication from the same SGLT2 inhibitor class.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin is not recommended during pregnancy, particularly in the second and third trimesters, due to potential risks to the developing fetal kidneys.
Actionable advice:
Avoid completely during pregnancy.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
It is not known if dapagliflozin passes into breast milk, but due to the potential for serious adverse reactions in a nursing infant, it is not recommended.
Actionable advice:
Avoid completely while breastfeeding.
Target id:
/biomarker/1-5-ag-assay
Target name:
1,5-Anhydroglucitol (1,5-AG) Assay
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin causes glucose excretion in the urine, which directly invalidates the 1,5-AG assay, making it a completely unreliable marker for monitoring short-term glycemic control.
Actionable advice:
Do not use the 1,5-AG test to monitor blood sugar control; use HbA1c, CGM, or blood glucose monitoring instead.
Target id:
/biomarker/urine-glucose-test
Target name:
Urine Glucose Test
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
null
Description:
The primary mechanism of dapagliflozin is to force glucose into the urine. Therefore, urine glucose tests will always be positive and cannot be used to assess blood sugar levels.
Actionable advice:
Do not use urine glucose strips to monitor your blood sugar levels, as they will be misleadingly positive.
Target id:
/dietary/water
Target name:
Adequate Fluid Intake
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Because dapagliflozin causes the body to lose water via urination, maintaining adequate hydration is essential to prevent volume depletion, low blood pressure, and potential kidney problems.
Actionable advice:
Ensure you drink plenty of fluids throughout the day while taking this medication.
Target id:
/class/nephrotoxic-agents
Target name:
Nephrotoxic Agents (NSAIDs, ACEi, ARBs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining dapagliflozin with NSAIDs and ACE inhibitors or ARBs (the 'triple whammy') can increase the risk of acute kidney injury, especially during episodes of dehydration.
Actionable advice:
Use extreme caution with this combination; avoid NSAIDs if possible and always maintain excellent hydration.
Target id:
/dietary/alcohol-acute
Target name:
Alcohol
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Excessive alcohol consumption can impair glucose production by the liver and contribute to dehydration, increasing the risk of both hypoglycemia and ketoacidosis when taking dapagliflozin.
Actionable advice:
Limit alcohol consumption and avoid binge drinking to minimize risks.
Target id:
/intervention/lithium
Target name:
Lithium
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin's diuretic effect can increase the renal clearance of lithium, potentially leading to lower lithium levels in the blood and a reduced therapeutic effect.
Actionable advice:
Monitor serum lithium levels closely if starting, stopping, or changing the dose of dapagliflozin.
Target id:
/intervention/rifampin
Target name:
Rifampin
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Rifampin is a strong inducer of the UGT1A9 enzyme, which is the primary metabolic pathway for dapagliflozin. This can significantly lower dapagliflozin levels, reducing its effectiveness.
Actionable advice:
Consider an increased dose of dapagliflozin or an alternative therapy if co-administration with rifampin is necessary.
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin has a mild blood pressure-lowering effect due to fluid loss. When combined with other blood pressure medications, it can increase the risk of symptomatic low blood pressure (hypotension).
Actionable advice:
Monitor blood pressure, especially when starting therapy or adjusting doses of other antihypertensives.
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Older adults are more susceptible to the volume-depleting effects of dapagliflozin, which increases their risk of falls, low blood pressure, and kidney impairment.
Actionable advice:
Use with caution in older adults, often starting with a lower dose and monitoring closely for side effects.
Target id:
/circadian/wake
Target name:
Waking Up (Morning)
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
null
Hours after target:
2
Description:
Taking dapagliflozin in the morning is often recommended to align its diuretic effect with daytime hours, which can help minimize sleep disruption from nighttime urination (nocturia).
Actionable advice:
Take your dose in the morning to avoid disrupting your sleep.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin's absorption and effectiveness are not significantly impacted by the presence of food, which allows for flexible dosing relative to meals.
Actionable advice:
This medication can be taken with or without food according to your preference.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Dapagliflozin may slightly increase the peak concentration of digoxin. This effect is generally small and not considered clinically meaningful for most patients.
Actionable advice:
No specific action is typically required, but clinical monitoring is appropriate when co-administering with narrow therapeutic index drugs.