Meta Information
ID:dapagliflozin
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/loop-diuretics
Target name:
Loop Diuretics (e.g., Furosemide)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
This combination should be avoided unless under strict medical supervision with close monitoring of hydration and kidney function.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Furosemide may cause fluid, electrolyte, and metabolic abnormalities such as hypovolemia, hypokalemia, azotemia, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypocalcemia, hyperglycemia, or hyperuricemia, particularly in patients receiving higher dos
Label source:
FDA label: Furosemide (target-side evidence)
Action type:
avoid
Target id:
/class/antidiabetic-medications
Target name:
Insulin and Insulin Secretagogues (e.g., Sulfonylureas)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
( 5.3 ) Hypoglycemia : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with dapagliflozin tablets.
Label source:
FDA label: Dapagliflozin
Action type:
adjust_with_prescriber
Target id:
/condition/renal-impairment
Target name:
Renal Impairment (Kidney Disease)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
This should be strictly avoided if eGFR is below the recommended threshold (typically <25-30 mL/min/1.73m²).
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Data Animal Data Dapagliflozin dosed directly to juvenile rats from postnatal day (PND) 21 until PND 90 at doses of 1, 15, or 75 mg/kg/day, increased kidney weights and increased the incidence of renal pelvic and tubular dilatations at all dose levels.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/intervention/ketogenic-diet
Target name:
Ketogenic Diet
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Dapagliflozin should not be used while following a strict ketogenic diet due to the high risk of eDKA.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
other ketoacidosis include under-insulinization due to insulin dose reduction or missed insulin doses, acute febrile illness, reduced caloric intake, ketogenic diet, surgery, volume depletion, and alcohol abuse.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
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:
Dapagliflozin should be stopped at least 3 days before any major surgery or stressful medical procedure.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
GFR less than 25 mL/min/1.73 m 2 . 2.4 Temporary Interruption for Surgery Withhold dapagliflozin tablets for at least 3 days, if possible, prior to major surgery or procedures associated with prolonged fasting.
Label source:
FDA label: Dapagliflozin
Action type:
informational_none
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Dapagliflozin should not be taken when acutely ill or dehydrated; full rehydration is needed before resuming the medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Inform patients that dehydration may increase the risk for hypotension, and to have adequate fluid intake.
Label source:
FDA label: Dapagliflozin
Action type:
separate
Target id:
/class/sglt2-inhibitors
Target name:
Other SGLT2 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Dapagliflozin should never be combined with another medication from the same SGLT2 inhibitor class.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Discontinue dapagliflozin tablets, closely monitor blood glucose levels, and provide appropriate alternative therapy for glycemic control. 5.6 Genital Mycotic Infections Dapagliflozin tablets increases the risk of genital mycotic infections.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
This should be strictly avoided during pregnancy.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
USE IN SPECIFIC POPULATIONS Pregnancy : Advise females of the potential risk to a fetus especially during the second and third trimesters.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
It should be avoided completely while breastfeeding.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Because of the potential for serious adverse reactions in breastfed infants, advise women that use of dapagliflozin tablets is not recommended while breastfeeding.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/biomarker/1-5-ag-assay
Target name:
1,5-Anhydroglucitol (1,5-AG) Assay
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
The 1,5-AG test should not be used to monitor blood sugar control; HbA1c, CGM, or blood glucose monitoring is appropriate instead.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Intervention Monitoring glycemic control with 1,5-AG assay is not recommended.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/biomarker/urine-glucose-test
Target name:
Urine Glucose Test
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Urine glucose strips should not be used to monitor blood sugar levels, as they will be misleadingly positive.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Intervention Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors.
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/dietary/water
Target name:
Adequate Fluid Intake
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Plenty of fluids should be consumed throughout the day while taking this medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Inform patients that dehydration may increase the risk for hypotension, and to have adequate fluid intake.
Label source:
FDA label: Dapagliflozin
Action type:
informational_none
Target id:
/class/nephrotoxic-agents
Target name:
Nephrotoxic Agents (NSAIDs, ACEi, ARBs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Extreme caution is warranted with this combination; NSAIDs are best avoided if possible, and excellent hydration is important to maintain.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
If co-medication is considered necessary, monitoring of serum potassium is advisable. 7.2 Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX- 2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2
Label source:
FDA label: Valsartan (target-side evidence)
Action type:
avoid
Target id:
/dietary/alcohol-acute
Target name:
Alcohol (Acute Consumption)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Alcohol consumption is best limited, and binge drinking is best avoided to minimize risks.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
(such as insulin dose reduction or missed insulin doses, infection, reduced caloric intake, ketogenic diet, surgery, dehydration, and alcohol abuse) and symptoms of ketoacidosis (including nausea, vomiting, abdominal pain, tiredness, and labored breathing).
Label source:
FDA label: Dapagliflozin
Action type:
avoid
Target id:
/intervention/lithium
Target name:
Lithium
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Serum lithium levels should be monitored closely if starting, stopping, or changing the dose of dapagliflozin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Intervention Monitor serum lithium concentration more frequently during dapagliflozin tablets initiation and dosage changes.
Label source:
FDA label: Dapagliflozin
Action type:
monitor
Target id:
/intervention/rifampin
Target name:
Rifampin
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Concomitant use of lurasidone with strong CYP3A4 inducers (e.g., rifampin) decreased the exposure of lurasidone compared to the use of lurasidone alone (see PRECAUTIONS, Drug Interactions).
Label source:
FDA label: Rifampin (target-side evidence)
Action type:
informational_none
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
Blood pressure should be monitored, especially when starting therapy or adjusting doses of other antihypertensives.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Renal impairment: Monitor renal function periodically (5.3) • Hypotension: Patients with other heart or renal diseases have increased risk, monitor blood pressure after initiation (5.4) • Hyperkalemia: Monitor serum potassium periodically (5.5) • Cholestatic jaundice and hepatic failure: Monitor for jaundice or signs of liver failure (5.6) Pregnancy Category D Use of drugs that act on the renin-an
Label source:
FDA label: Lisinopril (target-side evidence)
Action type:
monitor
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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:
This is best used with caution in older adults, often starting with a lower dose and monitoring closely for side effects.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
However, due to AstraZeneca AB's marketing exclusivity rights, this drug product is not labeled with that information. 8.5 Geriatric Use No dapagliflozin tablets dosage change is recommended based on age.
Label source:
FDA label: Dapagliflozin
Action type:
monitor
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:
A dose is generally best taken in the morning to avoid disrupting sleep.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
the recommended starting dose of FARXIGA is 5 mg orally once daily, taken in the morning, with or without food
Label source:
FDA label: Dapagliflozin (Farxiga)
Action type:
avoid
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
informational
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
These changes are not considered to be clinically meaningful and dapagliflozin can be administered with or without food
Label source:
FDA label: Dapagliflozin (Farxiga)
Action type:
informational_none
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
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.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Dapagliflozin did not meaningfully affect the pharmacokinetics of the coadministered drugs
Label source:
FDA label: Dapagliflozin (Farxiga)
Action type:
monitor