SGLT2 Inhibitors
(Type 2 Diabetes Drug Class)

SGLT2 (sodium-glucose co-transporter 2) inhibitors are prescription oral medications used to treat type 2 diabetes.

Brand and generic names of SGLT2 inhibitors and combination products that contain SGLT2 inhibitors include:

• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)
• empagliflozin/linagliptin (Glyxambi)
• empagliflozin/metformin (Synjardy)
• dapagliflozin/metformin (Xigduo XR)

Yes

• 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.

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

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

• 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.

• 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.

SGLT2 inhibitors are available as tablets.

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

• 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.