Farxiga Sleep Architecture Impact: What Dapagliflozin Does to Your Sleep

Does dapagliflozin act on the brain to change sleep?

Dapagliflozin works in the kidney by blocking sodium-glucose cotransporter 2, so more glucose is excreted in urine and an osmotic diuresis results [1].

Sleep architecture, the split of a night between light sleep, slow-wave sleep and REM, is read from EEG or polysomnography. No sleep-stage effect of dapagliflozin is established.

Urine at night, and the timing question

Glucosuria is the drug's central mechanism, and the label's pooled trial table reflects it: increased urination in 1.7% of people on placebo, 2.9% on 5 mg and 3.8% on 10 mg, and discomfort with urination in 0.7%, 1.6% and 2.1% [1]. Urinary tract infection was reported by 3.7%, 5.7% and 4.3% [1].

The label says to take dapagliflozin with or without food and gives no hour of day [1]. Plasma levels peak within about 2 hours of a dose and the half-life is about 12.9 hours [1].

Genital infections and sleep

The label lists female genital mycotic infections among its most common adverse reactions, along with nasopharyngitis and urinary tract infections [1]. In women the rates were 8.4% on 5 mg and 6.9% on 10 mg against 1.5% on placebo; in men they were 2.8% and 2.7% against 0.3% [1]. The label says to monitor for genitourinary infections and treat promptly, and to evaluate genital or perineal pain, tenderness, redness or swelling with fever or malaise for necrotizing fasciitis [1].

Other label warnings

The label describes volume depletion as symptomatic hypotension and acute transient changes in creatinine, with higher risk at eGFR below 60, in older adults and in people on loop diuretics; in the DECLARE loop-diuretic subgroup, volume-depletion events were 6.6% on dapagliflozin versus 6.1% on placebo [1]. It says ketoacidosis can present with nausea, vomiting, abdominal pain and shortness of breath, with blood glucose possibly below 250 mg/dL [1]. It also says hypoglycemia risk rises with insulin or an insulin secretagogue, and that dapagliflozin should be withheld for at least 3 days, if possible, before surgery or prolonged fasting [1].