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Dapagliflozin should not be used in
patients with moderate renal impairment
(eGFR < 60 mL/min/1.73 m2) or
worse.10 Monitoring of renal function is
recommended as follows:
Prior to initiation of canagliflozin or
Prior to initiation of concomitant
medicines that may reduce renal
For renal function approaching
moderate renal impairment, at least
two to four times per year. If renal
function consistently falls to stage
3B CKD (EGFR < 45 ml/min/1.73 m2)
treatment with canagliflozin should
If renal function falls persistently
below eGFR < 60 mL/min/1.73 m2
treatment with dapagliflozin should
• As the SGLT2 inhibitors promote the
excretion of calories (i.e. glucose)
and there may be some loss of
sodium, these agents may promote
weight loss and a reduction in
blood pressure5. However, there
are no data regarding the long-
term outcomes from the use of
dapagliflozin or canagliflozin.
Long-term cardiovascular outcomes
form the DECLARE-TIMI158 study of
dapagliflozin are due in 2019.
this new class of medication does not
result in any bitter sweet outcomes.
1. Australian Government, Australian Institute of Health and
Welfare. Prevalence of diabetes. 2013.At: www.aihw.gov.
2. Ismail-Beigi F. Clinical practice. Glycemic management of
type 2 diabetes mellitus. N Engl J Med 2012;366:1319–27.
3. Cheung NW, Conn JJ, d’Emden MC, et al; Society.
Position statement of the Australian Diabetes Society:
individualisation of glycated haemoglobin targets for
adults with diabetes mellitus. Med J Aust. 2009 Sep
4. Standards of medical care in diabetes--2014.American
Diabetes Association.Diabetes Care. 2014 Jan;37 Suppl
5. Davis T. Sodium-glucose co-transporter inhibitors. Austr
6. Pharmaceutical Benefits Schedule Items Report. At:
7. Australian Government Department of Health
(Therapeutic goods Administration). Database of Adverse
Event Notifications – medicines. At: http://apps.tga.gov.
8. Lindstrom SJ, Nagalingam V, Newnham HH. Impact of the
2009 Melbourne heatwave on a major public hospital.
Intern Med J. 2013 Nov;43(11):1246–50. doi: 10.1111/
9. Invokana Product Information. MIMS.
10. Forxiga Product Information. MIMS.
11. ClinicalTrials.gov. Multicentre trial to evaluate the effect of
dapagliflozin on the incidence of cardiovascular events
(DECLARE TIMI158). At: http://clinicaltrials.gov/show/
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