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Clinical recommendations based upon the patients renal function include [see Dosage and Administration (2.1, 2.4) and Clinical Pharmacology (12.3)]: Drug Interactions: The concomitant use of dapagliflozin and metformin HCl extended-release with specific drugs may increase the risk of metformin-associated lactic acidosis: those that impair renal function, result in significant hemodynamic change, interfere with acid-base balance or increase metformin accumulation (e.g., cationic drugs) [see Drug Interactions (7)]

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This knowledge gap is increasingly relevant given the surge in GLP-1 RA prescriptions and ongoing discussions about how these medications compare to or complement surgical interventions

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