📋 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 18-84 yrs: 10 mg once daily, may be increased to 25 mg once daily if necessary
Adult 85 yrs and over: Initiation not recommended
⛔ Contraindications
Diabetic ketoacidosis, severe hepatic impairment, severe renal impairment. Elderly over 85 yrs age
⚠️ Precautions & Warnings
Congestive heart failure and cardiovascular disease, hepatic impairment, renal impairment, complicated urinary tract infections; consider temporarily interrupting treatment. Avoid initiation if eGFR below 60 ml/minute/1.73m2. Avoid if eGFR is persistently below 45 ml/minute/1.73m2. Monitor renal function before starting treatment and regularly during treatment. Monitor electrolyte balance and ensure adequate hydration. Correct hypovolaemia before starting treatment. Consider interrupting treatment if volume depletion occurs, concomitant antihypertensive therapy or use of diuretics. Dose of concomitant insulin may need to be reduced.
🔄 Drug Interactions
Diuretics, antihypertensive, UGT enzyme inducers, agents affecting renal functions
⚠️ Adverse Reactions / Side Effects
Genital infection, hypoglycaemia (in combination with insulin or sulfonylurea), polyuria, pruritus, urinary tract infection, dysuria, volume depletion (rare)
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Advised to avoid
Lactation / Breastfeeding:
Advised to avoid
📚 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.