What are SGLT2 inhibitors?
SGLT2 (sodium-glucose co-transporter 2) inhibitors are prescription oral medications used to treat type 2 diabetes.
- SGLT2 inhibitors are used alone or in combination with metformin or other diabetic medications and with exercise and diet to reduce blood glucose in adults with type 2 diabetes.
- SGLT2 inhibitors are not for treating people with type 1 diabetes or for treating diabetic ketoacidosis.
- SGLT2 inhibitors are not prescribed for patients with kidney disease including those on dialysis.
What generic and brand names of SGLT2 inhibitors are available in the US?
Brand and generic names of SGLT2 inhibitors and combination products that contain SGLT2 inhibitors include:
- canagliflozin (Invokana)
- canagliflozin/metformin (Invokamet)
- canagliflozin/metformin extended release (Invokamet XR)
- dapagliflozin (Farxiga)
- dapagliflozin/metformin extended release (Xigduo XR)
- dapagliflozin/saxagliptin (Qtern)
- empagliflozin (Jardiance)
- empagliflozin/linagliptin (Glyxambi)
- empagliflozin/metformin (Synjardy)
- empagliflozin/metformin extended release (Synjardy XR)
- ertugliflozin (Steglatro)
- ertugliflozin/metformin (Segluromet)
- ertugliflozin/sitagliptin (Steglujan)
Do I need a prescription for SGLT2 inhibitors?
Yes
How do SGLT2 inhibitors work?
- SGLT2 inhibitors reduce blood glucose by blocking the action of a protein called sodium-glucose co-transporter-2 (SGLT2) in the kidney. This protein is responsible for reabsorbing sugar back into the body from urine. Blocking this protein prevents the kidney from reabsorbing glucose from urine and causes glucose to be removed from the body through urine. This lowers the level of glucose in the blood.
- SGLT2 inhibitors also reduce blood pressure and cause weight loss. In one study, empagliflozin (Jardiance) significantly reduced the risk of death from cardiovascular causes, death from any cause, and the risk of hospitalization for heart failure in people with type 2 diabetes.
- The FDA approved the first SGLT2 inhibitor, canagliflozin (Invokana), in 2013.
SLIDESHOW
Type 2 Diabetes: Signs, Symptoms, Treatments See SlideshowWhat are the side effects of SGLT2 inhibitors?
WARNING
On Aug. 29, 2018, the FDA issued a warning that cases of a rare but serious infection of the genitals and area around the genitals have been reported with the class of type 2 diabetes medicines called SGLT2 inhibitors. This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fournier’s gangrene.
SGLT2 inhibitors are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine. First approved in 2013, medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. In addition, empagliflozin is approved to lower the risk of death from heart attack and stroke in adults with type 2 diabetes and heart disease. Untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease.
Seek medical attention immediately if you experience any symptoms of tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, and have a fever above 100.4 F or a general feeling of being unwell. These symptoms can worsen quickly, so it is important to seek treatment right away.
On May 15, 2015, the FDA informed the public that SGLT2 inhibitors have been associated with increased risk of ketoacidosis in people with diabetes.
Common side effects
The most common side effect of SGLT2 inhibitors include:
- Genital yeast infections in men and women
- Urinary tract infections (UTIs)
- Increased urination
- Kidney problems
- Flu like symptoms
- Constipation
- Nasal congestion
- Urinary discomfort
- Back pain
Serious side effects of SGLT2 inhibitors include:
- Kidney failure
- Hyperkalemia (high levels of potassium in the blood)
- Hypotension (low blood pressure)
- Ketoacidosis
- Increased cholesterol levels
- Serious urinary tract infections
- Increased bladder cancer risk
- Serious allergic reactions
- Low blood glucose (hypoglycemia) when combined with insulin or drugs that increase insulin production
- Dehydration
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What are the dosages for SGLT2 inhibitors?
SGLT2 inhibitors are available as tablets.
- canagliflozin (Invokana): 100, 300 mg tablets
- dapagliflozin (Farxiga): 5, 10 mg tablets
- empagliflozin (Jardiance): 10, 25 mg tablets
Which drugs interact with SGLT2 inhibitors?
- Combining SGLT2 inhibitors with insulin or drugs that increase insulin secretion increases the risk of hypoglycemia.
- Combining SGLT2 inhibitors with diuretics increases the frequency of urination and the risk of dehydration.
- Rifampin, phenytoin, phenobarbital, ritonavir (Norvir) increase the removal of canagliflozin from the body by increasing the action of UDP glucuronosyl transferases (UGT) enzymes. UGT are enzymes that convert chemicals in the body to other types of chemicals that dissolve better in water and are easier to remove from the body. This interaction may reduce the efficacy of canagliflozin. Therefore, the dose of canagliflozin may need to be increased when it is combined with drugs that increase its removal form the body.
- Canagliflozin increases blood levels and the effect of digoxin.
- The prescribing information for dapagliflozin does not list any drug interactions.
Are SGLT2 inhibitors safe to take during pregnancy or while breastfeeding?
SGLT2 inhibitors have not been adequately evaluated in pregnant women. SGLT2 inhibitors affected kidney development and maturation in animals.
It is unknown whether SGLT2 inhibitors are secreted in human breast milk. To avoid any risk to the infant, breastfeeding women should stop either SGLT2 treatment or breastfeeding.
Summary
SGLT2 (sodium-glucose co-transporter 2) inhibitors is a class of drugs prescribed to treat type 2 diabetes in conjunction with diet and exercise. Review side effects, drug interactions, preparations, and pregnancy and breastfeeding safety information prior to taking any medication.
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Normal Blood Sugar Levels in Adults with DiabetesPeople with diabetes can manage and prevent low or high blood sugar levels (hyperglycemia or hypoglycemia) by keeping a log of their blood sugar levels when they are eating and fasting and eating foods that are high in carbohydrates and sugar, for example, buttered potatoes, candy, sugary desserts, and fatty foods. Blood tests, for example, the hemoglobin A1c test (A1c test) and urinalysis can diagnose the type of diabetes the person has. Diabetes during pregnancy, called gestational diabetes, should be managed by you and your OB/GYN or another healthcare professional. Extremely high levels of blood glucose in the blood can be dangerous and life-threatening if you have type 1, type 2, or gestational diabetes.
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Diabetes Mellitus (Type 1 and Type 2)Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue.
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Type 1 vs. Type 2 Diabetes: Similarities and DifferencesDiabetes is a metabolic disease that involves a problem with the way insulin is processed in the body. People with type 1 diabetes usually are diagnosed during childhood and have a problem with insulin production by the pancreas. On the other hand, type 2 usually is caused by poor diet, lack of exercise and activity, or being overweight. However, there are genetic causes for both of these types of diabetes.
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Type 2 DiabetesType 2 diabetes is a chronic condition that may be reversible with diet and lifestyle changes. Symptoms include excessive thirst, frequent urination, weight loss, fatigue, and an unusual odor to your urine. Most people don't know they have type 2 diabetes until they have a routine blood test. Treatment options include medications, a type 2 diabetes diet, and other lifestyle changes.
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Signs of Diabetes in MenEarly symptoms of diabetes are different in men, such as low testosterone. In many cases, prediabetes that will progress to type 2 diabetes if it is not treated early.
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Which is Worse - Type 1 or Type 2 Diabetes?Learn about the similarities and differences between Type 1 and Type 2 Diabetes.
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Diabetes TreatmentThe major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
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Early Signs of Diabetes in Women: Symptoms and What to Watch ForDiabetes symptoms in women include vaginal itching, pain, or discharge, loss of interest or pain after having sex, polycystic ovarian syndrome (POS), and urinary tract infections or UTIs (which are more common in women. Symptoms of diabetes that are the same in women and men are excessive thirst and hunger, bad breath, and skin infections, darkening of skin in areas of body creases (acanthosis nigricans), breath odor that is fruity, sweet, or acetone, and tingling or numbness in the hands or feet, blurred vision, fatigue, tingling or numbness in the hands or feet, wounds that heal slowly, irritability, and weight loss or gain. Complications of type 1 and type 2 diabetes are the same, for example, skin, eye, and circulation problems, low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), ketoacidosis, and amputation. If diabetes is not managed a person may not survive.
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Diabetic DietA diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, and eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
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Diabetic NeuropathyDiabetic neuropathy is a condition in which nerve damage has occurred as a complication of diabetes. The pain from the nerve damage can be severe with tingling or numbness in the part of the body affected. Diabetic neuropathy can occur anywhere in the body. Diabetic neuropathy can cause symptoms like intense pain, numbness, burning, or tingling in the part of the body affected by the condition. There are four types of neuropathy, which include peripheral, autonomic, proximal, and focal. Natural therapies and medications may help relieve the pain and other symptoms of diabetic neuropathy.
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Eye Problems and DiabetesDiabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
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What Are the Early Signs of Diabetes?The early signs of diabetes depend on if one has type 1 or type 2 diabetes. Type 1 diabetes usually occurs in children, whereas type 2 diabetes is prevalent in adults.
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Types of Diabetes Type 2 MedicationsConsumer information about the types of type 2 diabetes medications. Read about the side effects of Precose, Diabinese, Amaryl, Glucophage, Actos, Avandia, Starlix, Prandin, and more. Drug interactions, dosing, storage, and breastfeeding and pregnancy safety information is provided.
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Diabetes Foot ProblemsDiabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
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Diabetic Home Care and MonitoringManaging your diabetes is a full time commitment. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information will enable you to mange your diabetes at home successfully.
Medications & Supplements
- Mounjaro (tirzepatide)
- insulin NPH
- dapagliflozin/metformin
- dapagliflozin, Farxiga
- empagliflozin
- bromocriptine
- canagliflozin (Invokana)
- chlorpropamide, Diabinese
- Bydureon Bcise (exenatide)
- Synjardy XR (empagliflozin and metformin extended-release)
- ertugliflozin/sitagliptin
- empagliflozin/linagliptin/metformin hydrochloride
- Xultophy (insulin degludec and liraglutide injection)
Prevention & Wellness
- Weight Loss
- Snacks for Diabetes: 22 Healthy Ideas that Won’t Raise Blood Sugar
- Senior Exercise: How to Start At Home
- Exercise
- Aerobic Exercise
- Which Foods Are Bad for Kidney Disease and Diabetes?
- Weight Lifting
- What Are the Best Low-Carb Vegetables for People With Diabetes?
- Weight Management
- Yoga
- Benefits of Exercise
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
U.S. Food and Drug Administration. "FDA approves Invokana to treat type 2 diabetes First in a new class of diabetes drugs."
<https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345848.htm>
U.S. Food and Drug Administration. "FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes."
<https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes>
Zinman, B. et al. "Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes — NEJM." New England Journal of Medicine. N.p., 17 Sept. 2015. Web. 27 Apr. 2016.