- Type 2 Diabetes: Learn the Warning Signs
- Diabetes Friendly Dining
- Type 2 Diabetes: Test Your Medical IQ
- What are SGLT2 inhibitors?
- How do SGLT2 inhibitors work?
- What are the uses for SGLT2 inhibitors?
- What are the side effects of SGLT2 inhibitors?
- What are the dosages for SGLT2 inhibitors?
- Which drugs or supplements interact with SGLT2 inhibitors?
- Are SGLT2 inhibitors safe to take during pregnancy or while breastfeeding?
What are SGLT2 inhibitors?
SGLT2 (sodium-glucose co-transporter 2) inhibitors are prescription oral medications used to treat type 2 diabetes.
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 uses for SGLT2 inhibitors?
- 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.
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What 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

SLIDESHOW
Type 2 Diabetes: Signs, Symptoms, Treatments See SlideshowWhat 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 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.
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.
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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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Low Blood Sugar (Hypoglycemia)
Low blood sugar, or hypoglycemia, is a syndrome in which a person's blood sugar is dangerously low. People with type 1 and type 2 diabetes are at risk for this condition. There are other diseases that can cause a person's blood sugar levels to go too low, for example, pancreatitis, Cushing's syndrome, and pancreatic cancer. Symptoms and signs that your blood sugar levels are too low include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. If your blood sugars become too low, use these nearby as a quick treatment table sugar, soda, juice, and glucose tablets.
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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.
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Diabetes Treatment (Type 1 and Type 2 Medications and Diet)
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Diabetic Ketoacidosis (Causes, Symptoms, Treatment, Complications)
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Type 2 Diabetes
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Eye Problems and Diabetes
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Type 2 Diabetes Medications (Side Effects, Differences)
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Diabetes and Kidney Disease
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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.
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Diabetes: Caring for Your Diabetes at Special Times
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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.