Dapagliflozin, sold under the brand names Farxiga (US) and Forxiga (EU) among others, is a medication used to treat type 2 diabetes.

[20] Dapagliflozin is used along with diet, exercise, and usually with other glucose-lowering medications, to improve glycaemic control in adults with type 2 diabetes.

Recent studies have indicated that the use of dapagliflozin and other medications from the SGLT-2 inhibitor class can reduce the risk of worsening heart failure, death, and hospitalization from cardiovascular disease.

[25][26] SGLT-2 inhibitors reduce the risk of hospitalisation due to heart failure in people with or without atherosclerotic cardiovascular disease [27][28] A small number of meta-analyses and cohort studies have shown that dapagliflozin is superior to others such as empagliflozin.

[10] In 2021, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) expanded the indications for dapagliflozin to include the treatment of people who have chronic kidney disease but do not have diabetes.

The DIAMOND trial (2017–2019) showed in treatment periods of six weeks no improvement of excess proteins in the urine (proteinuria), a significant deterioration of the kidney's filtration rate (reversible within 6 weeks after dapagliflozin discontinuation), and a significant mean loss of body weight of 1.5 kg.

[38][39] The DAPA-CKD trial (2017–2020) showed in a median treatment period of 2.4 years of participants who had already been under ACE inhibitor (ACE) or angiotensin II receptor blocker (ARB) therapy that the events of a sustained decline of 50% in the kidney's filtration rate, kidney failure, or death occurred statistically around eight months later in the treatment group than in the placebo group.

Rarely, the use of an SGLT-2 inhibitor medication, including dapagliflozin, is associated with necrotizing fasciitis of the perineum, also called Fournier gangrene.

This gives an intermediate with an unwanted methoxy group at the anomeric centre, which is removed by reaction with triethylsilane in the presence of boron trifluoride etherate.

This consequently may lead to a reduction in preload and afterload, thereby alleviating cardiac workload and improving left ventricular function.

[57][58][59] In July 2016, the fixed-dose combination of saxagliptin and dapagliflozin was authorized for medical use in the European Union and is sold under the brand name Qtern.

[60] The combination drug was approved for medical use in the United States in February 2017, where it also is sold under the brand name Qtern.

[7] In two studies involving 840 participants with type 2 diabetes, dapagliflozin when used alone decreased HbA1c levels by 0.66% more than placebo (a dummy treatment) after 24 weeks.

[7] A long-term study, involving over 17,000 participants with type 2 diabetes, looked at the effects of dapagliflozin on cardiovascular (heart and circulation) disease.

[11] The results of the DAPA-HF and DECLARE-TIMI 58 clinical trials demonstrated the efficacy of dapagliflozin compared to placebo in improving survival in adults with heart failure with reduced ejection fraction by 17%.

They both showed a reduction in the number of hospitalizations from worsening heart failure, cardiovascular death and all-cause mortality.

[11] Participants were randomly assigned to receive a once-daily dose of either 10 mg of dapagliflozin or a placebo (inactive treatment).

[68] In August 2020, detailed results from the Phase III DAPA-CKD trial reportedly showed that dapagliflozin on top of standard of care reduced the composite measure of worsening of renal function or risk of cardiovascular or renal death by 39% compared to placebo (p<0.0001) in patients with chronic kidney disease stages 2–4 and elevated urinary albumin excretion.