SGLT-2 Inhibitors

Question 1

SGLT-2i MOA

Answer 1

• By inhibiting SGLT2, reabsorption of filtered glucose is reduced and the renal threshold for glucose (glucose reabsorption) is lowered
• Thereby increasing urinary glucose excretion

Question 2

SGLT-2i: Site of Action

Answer 2

• proximal renal tubules

Question 3

SGLT-2i Drugs

Answer 3

Invokana (canagliflozin)
Farxiga (dapagliflozin)
Jardiance (empagliflozin)
Steglatro (ertugliflozin)

Question 4

In non-diabetic individuals…

Answer 4

about 90% of glucose is reabsorbed at the proximal tubule (high capacisty of SGLT-2 transporters)

Question 5

When T2DM Pt takes SGLT2i…

Answer 5

it reduces blood glucose levels resulting from less glucose reabsorption

Question 6

Canagliflozin (Invokana): Dosing

Answer 6

• 100-300mg PO daily
• eGFR 45-60 mL/min: 100mg/day
• eGFR 30-44 mL/min: Not recommended

Question 7

Dapagliflozin (Farxiga): Dosing

Answer 7

• 5-10mg PO daily
• eGFR 30-59 mL/min: Not recommended

Question 8

Empagliflozin (Jardiance): Dosing

Answer 8

• 10-25mg PO daily
• eGFR 30-44 mL/min: Not recommended

Question 9

Ertugliflozin (Steglatro): Dosing

Answer 9

• 5-15mg PO daily
• eGFR 30-59 mL/min: Not recommended

Question 10

SGLT-2i: Side effects

Answer 10

• Genital mycotic infections [females>males]
• Increased urination
• UTIs
• Hypotension
• Weight loss
• Ketoacidosis - stay hydrated
• Fournier’s Gangrene
• Lower limb amputation & bone fractures [canagliflozin]
• Bladder cancer [dapagliflozin]
• Hyperkalemia [canagliflozin]

Question 11

SGLT-2i: Drug Interactions

Answer 11

• UGT enzyme inducers
• Rifampin, Ritonavir, Phenytoin, Phenobarbital
• Watch for hypotension, if patient is already using: ACE-I, ARB, Diuretics, digoxin (may alter level)

Question 12

SGLT-2i: Contraindication

Answer 12

• Dialysis
• Renal failure (eGFR<30ml/min)
• ESRD

Question 13

SGLT-2i: Precaution

Answer 13

• Hypotension
• Genital mycotic infections
• Urinary tract infections
• Acute kidney injury
• Ketoacidosis (euglycemic)
• Hyperkalemia
• Bladder Cancer
• Amputations

Question 14

SGLT-2i: Counseling points

Answer 14

• Take once a day; same time each day
• Hydration
• Hyperkalemia history
• Bladder cancer history
• Renal function status
• Discuss:
  In women: yeast infections/UTIs
  In men: circumcision status/UTIs/penile discharge