Forxiga is a tablet medication which helps to reduce blood glucose levels by helping the kidneys to remove glucose from the blood and excrete it within urine.
The drug helps to support weight loss but may raise the risk of genital thrush and urinary tract infections.
Because Forxiga is a relatively new medication, the long term effects of the drug, over several years, are as yet unknown.
- Trade name: Forxiga
- Generic name: Dapagliflozin
- Drug class: SGLT2 inhibitors
- Manufacturer: Bristol-Myers Squibb and AstraZeneca
How Forxiga helps in diabetes
Dapagliflozin helps lower blood glucose levels by helping the body to filter more excess glucose out of the blood.
As well as being effective in lowering blood glucose levels, by passing glucose out of the body, the accompanying calories in the excreted glucose is also passed out.
It is important, however, to ensure you maintain a healthy diet and take regular physical exercise in addition to taking Forxiga to keep your heart and the rest of your body healthy.
Mechanism of action
Dapagliflozin is in a class of drug called SGLT2 inhibitors. These drugs work by targeting and helping to stop sodium-glucose transport proteins from allowing glucose that has been filtered out of the blood by the kidneys to be reabsorbed back into the blood.
The SGLT2 proteins are responsible for 90% of the glucose that is reabsorbed into the blood. By inhibiting the SGLT2 proteins, Forxiga allows a significant amount of glucose in the blood to be removed by the kidneys and excreted in the urine.
Who is Forxiga suitable for?
The National Institute of Clinical Excellence (NICE) has approved Forxiga for use as a dual therapy treatment to be taken with metformin in adult patients in England and Wales who cannot tolerate sulphonylurea drugs.
In Scotland, Forxiga is suitable for use by adults with type 2 diabetes as a single treatment (monotherapy) or as an add-on treatment for people on metformin, sulphonylureas or insulin.
Who should not take dapagliflozin?
Dapagliflozin is not suitable for people who:
- Have type 1 diabetes
- Are pregnant or breastfeeding
- Have low kidney function
- Are galactose intolerant
- Have low salt levels in their body
- Are under the age of 18 or over the age 75
- People on a course of Actos (pioglitazone) or loop diuretics should also avoid taking Forxiga.
How and when to take Forxiga
Forxiga is taken in tablet form at doses of 10mg. Take with water once a day either with or without food.
Try to take Forxiga at around the same time each day and do not take more than one dose within a 12 hour period. If you miss a dose and your next dose is within 12 hours, wait until the next dose to resume the treatment.
Dapagliflozin tablets should always be kept in the original container and stored at room temperature. You must also make sure the medicine is kept out of the sight and reach of children.
Side effects of Forxiga may include:
- Hypoglycemia –if taken with sulphonylureas or insulin
- Urinary tract infections
- Increased need to visit the toilet (polyuria)
- Pain when urinating
- Changes in levels of blood fats
- Lowering of blood pressure
Please note the list above is not exhaustive. Refer to the patient information leaflet in the medication for a full list of side effects.
What to do if you take an overdose
If you take an overdose of Forxiga, contact your health team immediately for advice.
Long term safety
Clinical trials showed slight increases in the rate of patients with bladder, prostate and breast cancers amongst those taking Forxiga than in the group that took a placebo. The increased rate of these cancers was deemed to be not statistically significant.
Bladder cancer risk has received particular attention as the increase of sugar in the urine of people taking the drug could promote a favourable environment for the growth of tumours in the bladder, as noted above, trials to date have yet to show a significant increased risk however.
Animal tests on pregnant rats showed kidney damage occurred in their developing foetuses. Increased kidney damage has not been evident in adult mammals or humans in clinical trials but it is important your kidneys are regularly checked (at least once a year) when on Forxiga.
A similar drug, Invokana, which is in the same drug class as Forxiga, has been associated with a drop in eGFR, a marker which is used to measure kidney function and therefore there are questions over whether SGLT2 inhibitors will have a detrimental effect on the kidneys, over the long term, of patients taking these drugs or not.