SGLT2 Inhibitor Comparison Tool
Compare key attributes of Forxiga and other SGLT2 inhibitors to help determine which one might be best for your situation.
TL;DR
- Forxiga lowers blood sugar, aids weight loss, and protects the heart and kidneys.
- Jardiance, Invokana and Steglatro share the same class but differ in potency, dosing frequency and side‑effect profile.
- Choose Forxiga if you need a once‑daily dose, moderate HbA1c drop (≈0.7‑1.0%) and a lower risk of genital infections.
- Switch to another SGLT2 inhibitor when you need stronger glucose‑lowering or specific cardiovascular outcome data.
- Always weigh cost, insurance coverage and any contraindications before deciding.
What is Forxiga?
Forxiga is a SGLT2 (sodium‑glucose co‑transporter‑2) inhibitor approved for type2 diabetes management. It works by preventing the kidneys from re‑absorbing glucose, so excess sugar is expelled in the urine. The drug was first authorized by the FDA in 2014 and is marketed by AstraZeneca.
How does Forxiga work?
The SGLT2 protein resides in the proximal tubule of the kidney and is responsible for pulling about 90% of filtered glucose back into the bloodstream. By blocking this protein, Forxiga creates a controlled glucosuria, which translates into lower plasma glucose levels, modest calorie loss and a mild diuretic effect. The mechanism also lowers systolic blood pressure by 3‑5mmHg on average.
Key clinical benefits of Forxiga
Large phase‑III trials such as DECLARE‑TIMI58 demonstrated multiple advantages beyond glycaemic control.
- HbA1c reduction: Mean drop of 0.7‑1.0% over 24weeks.
- Weight loss: 2‑3kg average loss due to calorie excretion.
- Cardiovascular outcomes: 12% relative risk reduction in heart‑failure hospitalization.
- Renal protection: Slower decline in eGFR and reduced albuminuria progression.
Safety profile and common side effects
Because glucose is shunted into the urine, the most frequent adverse events are genital mycotic infections (about 4‑5% of users) and mild urinary tract infections. Volume depletion can occur, especially in older patients on diuretics. Rare but serious complications include ketoacidosis (euglycaemic) and severe hypoglycaemia when combined with insulin or sulfonylureas.
Alternative drugs in the same class
Forxiga belongs to the broader SGLT2 inhibitor family. The main competitors are:
- Jardiance - empagliflozin, approved 2014, proven 14% cardiovascular mortality cut.
- Invokana - canagliflozin, approved 2013, larger HbA1c drop (≈1.0‑1.2%).
- Steglatro - ertugliflozin, approved 2017, twice‑daily option for dose flexibility.
Non‑SGLT2 alternatives that doctors often consider alongside these agents include GLP‑1 receptor agonists (e.g., Ozempic) and DPP‑4 inhibitors (e.g., Januvia). Metformin remains first‑line therapy for most patients.
Direct comparison table
| Attribute | Forxiga (dapagliflozin) | Jardiance (empagliflozin) | Invokana (canagliflozin) | Steglatro (ertugliflozin) |
|---|---|---|---|---|
| FDA approval year | 2014 | 2014 | 2013 | 2017 |
| Typical dose | 10mg once daily | 10mg once daily | 100mg once daily | 5mg once daily (or 15mg) |
| HbA1c reduction (24wk) | 0.7‑1.0% | 0.6‑0.9% | 1.0‑1.2% | 0.7‑0.9% |
| Weight loss (kg) | 2‑3kg | 1‑2kg | 2‑4kg | 1‑2kg |
| Cardiovascular benefit | ↓ HF hospitalization (12%) | ↓ CV death (14%) | ↓ major adverse CV events (5%) | ↓ HF hospitalization (9%) |
| Renal outcome | Slower eGFR decline | Reduced progression to ESRD | Mixed renal data | Improved albuminuria |
| Common side effects | Genital infection (4%) | Genital infection (5%) | Genital infection (6%), amputation risk (rare) | Genital infection (5%) |
Choosing the right SGLT2 inhibitor
Decision making boils down to three practical axes:
- Efficacy needs: If you aim for the biggest HbA1c drop, Invokana tends to lead. For modest reductions with solid cardio‑renal safety, Forxiga and Jardiance are comparable.
- Safety considerations: Patients with a history of foot ulcers or peripheral artery disease may want to avoid Invokana because of the highlighted amputation warning. Those prone to genital infections might find Forxiga's slightly lower infection rate appealing.
- Practical factors: Once‑daily dosing, pill size, and insurance formularies often tip the scale. Forxiga’s 10mg tablet is small and fits most generic plans.
When you overlay these axes with patient‑specific factors (age, renal function, cardiovascular history), a clear hierarchy emerges. For many middle‑aged adults with early‑stage kidney disease, Forxiga offers a balanced mix of efficacy, safety, and convenience.
Cost and accessibility
Prices vary by country and insurance tier. In the UK, the NHS provides Forxiga at a standard price‑per‑tablet that is usually lower than the branded Jardiance or Invokana, especially after the 2023 generic dapagliflozin rollout. In the US, the average wholesale price (AWP) for a 30‑day supply hovers around $300 for brand name, while the generic version can be under $150.
Patients should ask their prescriber about patient‑assistance programs, as AstraZeneca and several charity groups still offer coupons for uninsured individuals.
Related therapeutic options
Understanding where Forxiga sits in the diabetes toolkit helps clinicians avoid overlapping mechanisms.
- Ozempic - a weekly GLP‑1 receptor agonist that drives weight loss (up to 6kg) and robust cardiovascular benefit.
- Januvia - a DPP‑4 inhibitor that offers modest HbA1c reduction (≈0.5‑0.7%) with minimal hypoglycaemia risk.
- Metformin - first‑line biguanide that reduces hepatic glucose output and improves insulin sensitivity.
Guidelines typically recommend pairing an SGLT2 inhibitor with metformin; adding a GLP‑1 agonist is considered when further weight loss or stronger cardio‑protection is needed.
Practical steps for clinicians and patients
- Confirm eGFR ≥45mL/min/1.73m² for Forxiga initiation.
- Review current antihypertensive and diuretic regimens to avoid volume depletion.
- Educate the patient on signs of genital infection and ketoacidosis, stressing prompt medical review if symptoms appear.
- Schedule a follow‑up HbA1c check at 12weeks; adjust dose or switch agents if target reduction isn’t met.
- Re‑evaluate cardiovascular risk annually; consider switching to Jardiance if the patient’s primary concern is cardiovascular mortality.
Future directions
Ongoing trials (e.g., DAPA‑CKD2, DAPA‑HF3) are exploring dapagliflozin’s role in non‑diabetic kidney disease and heart‑failure with preserved ejection fraction. Early data suggest a class effect, but subtle differences in renal outcomes could further refine drug selection.
Frequently Asked Questions
What makes Forxiga different from other SGLT2 inhibitors?
Forxiga’s key distinctions are its modest HbA1c reduction, a slightly lower rate of genital infections, and a once‑daily 10mg tablet that fits most insurance formularies. While the cardiovascular benefit is solid, Jardiance shows a clearer mortality advantage, and Invokana offers the biggest glucose drop but carries a rare amputation warning.
Can I use Forxiga if I have moderate kidney disease?
Yes, Forxiga is approved for patients with an eGFR down to 45mL/min/1.73m². Below that threshold, dose reduction isn’t recommended and clinicians usually switch to an alternative or stop the drug.
Do I need to monitor my blood sugar more often when starting Forxiga?
If you’re already on metformin or a DPP‑4 inhibitor, routine fasting glucose checks are enough. When Forxiga is added to insulin or a sulfonylurea, weekly glucose monitoring for the first 2‑3weeks helps catch any hypoglycaemia early.
Is there a risk of ketoacidosis with Forxiga?
Euglycaemic ketoacidosis is rare (<0.1% of users) but can occur, especially in low‑carb diets, prolonged fasting, or during acute illness. Patients should stop the drug and seek medical attention if they develop nausea, vomiting, abdominal pain, or breathing difficulties.
How does the cost of Forxiga compare to Jardiance and Invokana?
In the UK, the NHS price for generic dapagliflozin (Forxiga) is typically 10‑15% lower than the branded Jardiance or Invokana. In the US, the generic version is about half the price of brand‑name empagliflozin or canagliflozin, but exact out‑of‑pocket costs depend on individual insurance plans.
