SGLT2 Inhibitors (Sodium-Glucose Co-Transporter 2)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Do I need a prescription for SGLT2 inhibitors?

Yes

Why are of SGLT2 inhibitors prescribed to patients?

What are the side effects of SGLT2 inhibitors?

The most common side effect of SGLT2 inhibitors include:

Serious side effects of SGLT2 inhibitors include:

On May 15, 2015, the FDA informed the public that SGLT2 inhibitors have been associated with increased risk of ketoacidosis in people with diabetes.

Which drugs or supplements 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.

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Are of SGLT2 inhibitors safe to take during pregnancy or while breastfeeding?

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Are of 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.

What preparations of SGLT2 inhibitors are available?

SGLT2 inhibitors are available as tablets.

  • canagliflozin (Invokana): 100, 300 mg tablets
  • dapagliflozin (Farxiga): 5, 10 mg tablets
  • empagliflozin (Jardiance): 10, 25 mg tablets

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.

REFERENCES:

Federal 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>

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.

Quick GuideDiabetes Diet: Healthy Meal Plans for Diabetes-Friendly Eating

Diabetes Diet: Healthy Meal Plans for Diabetes-Friendly Eating

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. The SGLT1 inhibitors approved for use in the US includes:

Drug interactions, preparations, and pregnancy and breastfeeding safety should be reviewed prior to taking any medication.

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Reviewed on 11/3/2016
References
REFERENCES:

Federal 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>

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.

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