The National Health Service has issued an urgent alert to patients taking a widely prescribed medication, advising them to seek immediate medical attention if they develop any of three specific sets of symptoms. The warning concerns the drug dapagliflozin, a common treatment for type 2 diabetes.
Understanding Dapagliflozin and Its Uses
Known under the brand name Forxiga, dapagliflozin is primarily used to manage blood sugar levels in people with type 2 diabetes. However, its use has been extended, and it is also prescribed for patients with heart failure and chronic kidney disease. The medication can be costly for the health service, with estimates suggesting it costs the NHS in England alone around £300 million per year.
It is sometimes dispensed in combination with other diabetes medicines. Common combination products include Xigduo (dapagliflozin with metformin) and Qtern (dapagliflozin with saxagliptin).
Urgent Symptoms Requiring Immediate Action
The NHS has clearly stated on its official website that patients should "call your doctor or call 111 now" if they experience any of the following rare but serious side effects while taking dapagliflozin.
Firstly, signs of severe dehydration require urgent attention. These include a very dry or sticky mouth, intense thirst, feeling unusually sleepy or tired, producing little or no urine, and having a fast heartbeat.
Secondly, symptoms indicative of a urinary tract infection (UTI) should not be ignored. These encompass a high temperature, feeling hot, cold, or shivery, a burning sensation when urinating, pain in the back or side, or noticing blood in the urine.
Thirdly, and most seriously, patients are warned to watch for signs of Fournier's gangrene, a rare but severe infection. This is characterised by severe pain, tenderness, redness, or swelling in the groin or perineal area, accompanied by a high temperature or a general feeling of being unwell.
Managing Common and Other Serious Side Effects
It is important to note that the severe reactions listed above are classified as "rare", affecting fewer than 1 in 10,000 people. More common side effects, which occur in more than 1 in 100 users, are typically mild and short-lived. The NHS provides advice on how to cope with these, which include thrush, back pain, urinating more often, dizziness, and mild skin rashes.
The health service advises speaking to a doctor or pharmacist if these common effects persist or remain bothersome despite following the recommended coping strategies.
Other significant risks involve blood sugar levels. Combining dapagliflozin with other diabetes drugs like insulin or sulfonylureas (e.g., gliclazide) can sometimes cause blood sugar to drop too low (hypoglycaemia). Additionally, a small number of people may develop diabetic ketoacidosis (DKA), a dangerous condition where the body starts running low on insulin and ketones build up.
Symptoms of DKA can develop over 24 hours and include nausea or vomiting, extreme thirst, confusion or unusual fatigue, tummy pain, breath that smells fruity (like pear drops or nail polish), and deeper or faster breathing. Patients are taught to monitor for these signs and manage the risk.
Finally, as with any medicine, a severe allergic reaction (anaphylaxis) is possible. The NHS instructs anyone experiencing symptoms of a severe allergic reaction to call 999 immediately.
