📋 Indications & Clinical Dosage
*Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), Type 2 diabetes mellitus in combination with insulin or other antidiabetic drugs (if existing treatment fails to achieve adequate glycaemic control):*
Adult 18-74 yrs: 10 mg once daily
Adult 75 yrs and over: Initiation not recommended
⛔ Contraindications
Diabetic ketoacidosis, elderly over 80 yrs age, moderate to severe renal failure, volume depletion
⚠️ Precautions & Warnings
Cardiovascular disease, heart failure, elderly; risk of hypotension, electrolyte disturbances, hypotension, raised haematocrit, pyelonephritis, urosepsis,glycosuria. Correct hypovolaemia before starting treatment to avoid risk of volume depletion. Consider interrupting treatment if volume depletion occurs. In severe hepatic impairment, initial dose should be 5 mg daily then increased according to response. In renal impairment avoid if eGFR less than 60 ml/minute/1.73m2 (ineffective).
🔄 Drug Interactions
Diuretics, antihypertensive, ACE inhibitors, angiotensin II antagonist, DPP4 inhibitors, incretin mimetics
⚠️ Adverse Reactions / Side Effects
Genital infection, hypoglycaemia (in combination with insulin or sulfonylurea), polyuria, pruritus, urinary tract infection, dysuria, haematocrit, volume depletion (rare)
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated
Lactation / Breastfeeding:
Contraindicated
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.