Table 3

Dose adjustment with renal function when using SGLT2 inhibitors (refs. 4547)

DrugeGFR (mL/min/1.73 m2)
<3030–4545–60>60
Dapagliflozin- Do not start drug- Do not start- Do not start drug- Start at 5 mg QD
- D/C if on drug- D/C if on drug- D/C if on drug and eGFR persistently <60- Increase to 10 mg QD as needed to decrease glucose
Canagliflozin- Do not start drug- Do not start drug- Start at 100 mg QD- Start at 100 mg QD
- D/C if on drug- D/C if on drug and eGFR persistently <45- Do not increase dose- Increase to 300 mg QD as needed to decrease glucose
- If on 300 mg, decrease dose to 100 mg
Empagliflozin- Do not start drug- Do not start- Start at 10 mg and increase to 25 mg QD as needed to decrease glucose- Start at 10 mg and increase to 25 mg QD as needed to decrease glucose
- D/C if on drug- D/C if on drug and eGFR <45 persistently
  • D/C, discontinued.