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.

QUESTION
______________ is another term for type 2 diabetes. See AnswerWhat 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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Related Disease Conditions
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Normal Blood Sugar Levels In Adults with Diabetes
People with diabetes can manage and prevent low or high blood sugar levels (hyperglycemia or hypoglycemia) by keeping a log of your blood sugar levels when you are eating and fasting and eat 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. If you or someone that you are with has extremely high blood glucose levels, call 911 or go to your nearest Urgent Care or Emergency Department immediately. To prevent and manage high blood glucose levels in people with diabetes keep a log of your blood sugar levels, eat foods that are high in carbohydrates sugar, for example, buttered potatoes, candy, sugary deserts, and fatty foods that you can share with your doctor and other healthcare professionals.
-
Diabetes (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. Treatment of diabetes depends on the type.
-
Low Blood Sugar (Hypoglycemia)
Low blood sugar or hypoglycemia occurs when blood sugar is dangerously low and is often complication of type 1 and type 2 diabetes. Learn about symptoms, dangers, and treatment.
-
High Blood Sugar (Hyperglycemia)
Hyperglycemia or high blood sugar is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms of high blood sugar may include increased thirst, headaches, blurred vision, and frequent urination.Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
-
Type 2 Diabetes Diet Plan
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.
-
Diabetes Symptoms in Women
Diabetes 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.
-
Type 2 Diabetes
Type 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.
-
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a complication of type 1 diabetes that is life threatening. If a person thinks they may have diabetic ketoacidosis they should seek medical care immediately. Diabetic ketoacidosis happens when a person's insulin levels in the blood become dangerously low. Symptoms of diabetic ketoacidosis include dehydration, abdominal pain, confusion, and nausea and vomiting. Diabetic ketoacidosis needs medical treatment. It cannot be treated at home.
-
Diabetes Symptoms in Men
Early 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.
-
Diabetes Treatment: Medication, Diet, and Insulin
The 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.
-
Diabetic Diet
A 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, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
-
Which is Worse - Type 1 or Type 2 Diabetes?
Learn about the similarities and differences between Type 1 and Type 2 Diabetes.
-
Type 1 vs. Type 2 Diabetes: Differences
Diabetes mellitus is a metabolic condition in which a person's blood sugar (glucose) levels are too high. Over 29.1 million children and adults in the US have diabetes. Of that, 8.1 million people have diabetes and don't even know it. Type 1 diabetes (insulin-dependent, juvenile) is caused by a problem with insulin production by the pancreas. Type 2 diabetes (non-insulin dependent) is caused by: Eating a lot of foods and drinking beverages with simple carbohydrates (pizza, white breads, pastas, cereals, pastries, etc.) and simple sugars (donuts, candy, etc.) Consuming too many products with artificial sweeteners (We found out that they are bad for us!) Lack of activity Exercise Stress Genetics While the signs and symptoms of both types of diabetes are the same, which include: Increased urination Increased hunger Increased thirst Unexplained weight loss. However, the treatments are different. Type 1 diabetes is insulin dependent, which means a person with this type of diabetes requires treatment with insulin. People with type 2 diabetes require medication, lifestyle changes like eating a healthy diet, and getting regular exercise.
-
What Is Diabetic Neuropathy?
Diabetic neuropathy 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 include peripheral, autonomic, proximal and focal. Natural therapies and medications may help relieve the pain and other symptoms of diabetic neuropathy.
-
Eye Problems and Diabetes
Diabetes 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.
-
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.
-
Diabetes Foot Problems
Diabetes 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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Types of Diabetes Type 2 Medications
Type 2 diabetes oral medications are prescribed to treat type 2 diabetes in conjuction with lifestyle changes like diet and exercise. There are nine classes of drugs approved for the treatment of type 2 diabetes. Examples of type 2 oral diabetes medications include acarbose (Precose), chlorpropamide (Diabinese), glipizide (Glucotrol, Glucotrol XL), and metformin (Glucophage). Side effects, drug interactions, warnings and precautions, dosage, and breastfeeding and pregnancy safety information should be reviewed prior to taking any medication.
-
Can Type 1 Diabetes be Cured?
Type 1 diabetes is a disorder of the pancreas. The organ doesn't make enough insulin. Learn what medical treatments can help ease your type 1 diabetes symptoms and speed up your recovery.
-
Tips for Managing Type 1 and 2 Diabetes at Home
Managing 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.
-
Can Type 2 Diabetes be Cured?
Type 2 diabetes is a long-term medical condition in which the body is not able to regulate blood sugar (glucose) level because of the inability of the body to properly use insulin. An individual can get type 2 diabetes because of a number of factors that reduce insulin action or quantity in the body. The goals of diabetes management are to eliminate symptoms and prevent the development of complications. Many drugs, both oral and injectable, are available for diabetes management.
-
What Are the Early Signs of Type 2 Diabetes?
Type 2 Diabetes is a chronic disease characterized by increased blood sugar (glucose) level. Type 2 Diabetes is caused by either insufficient insulin secretion or resistance to that hormone’s action. Insulin is produced by the pancreas and helps process the glucose in the blood. Thus, with inadequate insulin, the bodies can’t burn all the blood sugar for energy in an efficient way. This means the glucose level in the blood rises, causing a variety of symptoms and when severe may even lead to death.
Treatment & Diagnosis
Medications & Supplements
Prevention & Wellness
- Aerobic Exercise
- Weight Loss
- Weight Lifting (Resistance Exercise)
- Exercise
- Snacks for Diabetes: 22 Healthy Ideas that Won’t Raise Blood Sugar
- All About Yoga: Health Benefits
- Senior Exercise: How to Start At Home
- Which Foods Are Bad for Kidney Disease and Diabetes?
- What Are the Best Low-Carb Vegetables for People With Diabetes?
- Weight Management
- Does Sugar Cause Diabetes? Fact vs Fiction
- 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."
<http://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.