• Genital infections
  This medication may increase the chances of getting a genital infection of the vagina or penis. Symptoms include itch or unusual discharge from the genitals.
  
  
  • To minimise the chances of this happening, always practise good genital hygiene

• Urinary tract infection
  This medication may increase the chances of getting a urinary tract infection. Symptoms include a burning feeling when you pass urine, the need to pass urine more often, feeling like you need to pass urine more often, or if you see blood in your urine.
  
  
  • To minimise the chances of this happening, always practise good genital hygiene

• Low blood pressure
  You may feel giddy or light-headed, especially when you get up from a lying or sitting position. This is more likely to happen in the morning or when you first get out of bed.
  
  
  • Getting up slowly may help but if the problem continues, check with your doctor.

• Dehydration (not having enough water in the body)
  You may experience dehydration as it removes the excess sugar in your body through your urine.
  
  
  • You should take an extra 1 to 2 glasses of water every day unless your doctor tells you to control your liquid intake

• Low blood sugar
  Low blood sugar can happen and the chances of this happening are increased when you take this medication with other medications used in diabetes. Please inform your doctor if low blood sugar level occurs as your doctor may need to adjust your diabetes medications.
  
  
  • Weakness
  • Dizziness
  • Hunger
  • Sweating
  • Trembling
  • Blurred vision
  • Walking unsteadily
    
  • Fast heartbeat

Symptoms of low blood sugar include

If you experience any of these low blood sugar symptoms, do the following immediately:

Step 1: Check your blood sugar level with a home blood sugar meter (glucometer) if available. If your blood sugar level is less than 4 mmol/L, take 15 grams of fast-acting sugar. Example of 15 grams of fast-acting sugar include:

• 3 glucose tablets or
• Half a glass of fruit juice (200ml) or
• Half a can of soft drink or sweetened drink (175ml) or
• 1 can of less sugar soft drink (330ml) or
• 3 teaspoons of sugar, honey or syrup

Step 2: Monitor yourself for 15 minutes. If you have a glucometer (home blood sugar meter), check your blood sugar level again after 15 minutes.

Step 3: If your blood sugar level is still less than 4 mmol/L or you still have symptoms of low blood sugar, you should take another 15 grams of fast-acting sugar as per Step 1.

If your symptoms do not go away, see a doctor or go to the hospital immediately.

Step 4: Take your meal or snack if your blood sugar level is 4 mmol/L and above after consuming the fast-acting sugar earlier on.

• Diabetic ketoacidosis (DKA) 
• DKA is a rare and serious side effect associated with this medication.
• Symptoms include:  
• Pain in the stomach or abdominal area
• Nausea or vomiting that does not go away
• Feeling confused, tired or unusually sleepy
• Difficulty breathing (shortness of breath)
• Feeling very thirsty and sweet fruity smell in your breath 
• To lower the chances of DKA, make sure to drink enough water every day. Extended periods of fasting or large reductions in food intake may also increase the chances of DKA happening.
• Fournier’s gangrene
  
• This medication is also very rarely associated with a serious bacterial infection in the genital or perineal area. 
• You should stop the medication and seek medical attention immediately if you:
• Develop a fever above 38 °C
  
• Develop pain, redness or swelling in your genitals or in the area between your genitals and anus
• To minimise the chances of this happening, always practise good genital hygiene
• Ulcers or signs of infections on your feet (eg. pain or tenderness, redness, swollen appearance, feeling of warmth)

When to temporarily stop Dapagliflozin?

• When feeling unwell eg. high fever, loss of appetite, diarrhoea, vomiting or at risk of dehydration
• If you are pregnant

Ask your doctor if you need to stop this medication or take extra precautions, if you are planning for the following:

• Surgical or dental procedure
• A weight loss diet plan involving very low carbohydrate intake such as the ketogenic diet
• Endurance physical activities such as running a marathon
• Pregnancy
• Fasting during Ramadan

You are encouraged to check your blood sugar levels with a glucometer (blood sugar meter) as instructed by your healthcare professional. 

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