From the Guidelines
Interstitial cystitis is not an absolute contraindication to SGLT2 inhibitors, but caution is warranted. Patients with interstitial cystitis may experience worsening urinary symptoms when taking SGLT2 inhibitors like empagliflozin, dapagliflozin, canagliflozin, or ertugliflozin 1. These medications work by preventing glucose reabsorption in the kidneys, leading to increased urinary glucose excretion. This mechanism can potentially exacerbate the frequency, urgency, and discomfort already experienced by interstitial cystitis patients.
Key Considerations
- If an SGLT2 inhibitor is clinically indicated for diabetes or cardiorenal protection, start with the lowest available dose and monitor closely for symptom worsening.
- Consider alternative antidiabetic medications such as GLP-1 receptor agonists, DPP-4 inhibitors, or metformin if the patient experiences significant worsening of bladder symptoms.
- The decision to use these medications should be individualized based on the severity of interstitial cystitis symptoms, the need for glycemic control, and potential cardiovascular or renal benefits that SGLT2 inhibitors provide 1.
Monitoring and Adjustment
- Regular monitoring of urinary symptoms and renal function is essential when prescribing SGLT2 inhibitors to patients with interstitial cystitis.
- Dose adjustment or discontinuation of the medication may be necessary if significant worsening of symptoms occurs.
- The benefits and risks of SGLT2 inhibitors should be weighed carefully, considering the individual patient's risk profile and medical history 1.
From the Research
Interstitial Cystitis and SGLT2 Inhibitors
- Interstitial cystitis (IC) is a chronic pain disorder of the bladder that is often underdiagnosed and mistreated 2.
- SGLT2 inhibitors are a class of drugs used to treat type 2 diabetes by reducing glucose reabsorption in the kidneys 3, 4.
- There is no direct evidence to suggest that interstitial cystitis is an absolute contraindication to SGLT2 inhibitors.
- However, SGLT2 inhibitors have been associated with an increased risk of genital infections, including urinary tract infections (UTIs) 5.
- The risk of UTI is not significantly increased with SGLT2 inhibitors compared to placebo or active comparator, except for higher doses of dapagliflozin 5.
Considerations for Use
- The decision to use SGLT2 inhibitors in patients with interstitial cystitis should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
- Patients with interstitial cystitis who are considering SGLT2 inhibitors should be closely monitored for signs and symptoms of UTIs and other infections 5.
- The benefits and harms of SGLT2 inhibitors should be carefully weighed against other treatment options for type 2 diabetes, including GLP-1 receptor agonists 6.