Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors
For complete individual drug prescribing information (PI) and updates, please refer to the drug manufacturer or FDA websites.
Initiation
Select an initial dose of SGLT2 inhibitor based on patient’s eGFR. It is not necessary to achieve target or maximally tolerated doses of other drugs before adding SGLT2 inhibitor (EC).
Titration
No dose adjustment is needed.
Monitoring
After initiation and during titration, monitor (EC):
- Renal function
- Blood pressure
Contraindications and Cautions
Contraindications
- Not approved for use in patients with Type I diabetes due to increased risk of diabetic ketoacidosis
- Known hypersensitivity to drug
- Lactation (no data)
- On dialysis
Cautions
- For HF care, dapagliflozin, eGFR <30 mL/min/1.73m2
- For HF care, empagliflozin, eGFR <20 mL/min/1.73 m2
- Pregnancy
- Increased risk of mycotic genital infections
- May contribute to volume depletion. Consider altering diuretic dose if applicable
- Ketoacidosis in patients with diabetes:
- Temporary discontinuation before scheduled surgery is recommended to avoid potential risk for ketoacidosis
- Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level
- Acute kidney injury and impairment in renal function: Consider temporarily discontinuing in settings of reduced oral intake or fluid losses
- Urosepsis and pyelonephritis: Evaluate patients for signs and symptoms of urinary tract infections and treat promptly, if indicated
- Necrotizing fasciitis of the perineum (Fournier’s gangrene): Rare, serious, life-threatening cases have occurred in both female and male patients; assess patients presenting with pain or tenderness, erythema, or swelling in the genital or perineal area, along with fever or malaise