From the Guidelines
The recommended starting dosages for SGLT2 inhibitors in type 2 diabetes are: canagliflozin (Invokana) 100 mg once daily, empagliflozin (Jardiance) 10 mg once daily, dapagliflozin (Farxiga) 10 mg once daily, and ertugliflozin (Steglatro) 5 mg once daily, as supported by the most recent evidence from 1. These medications should be taken in the morning with or without food.
- Dosages may be increased if needed and if tolerated: canagliflozin can be increased to 300 mg daily, empagliflozin to 25 mg daily, dapagliflozin to 10 mg daily, and ertugliflozin to 15 mg daily.
- Dose adjustments are necessary for patients with reduced kidney function; generally, these medications are not recommended when eGFR falls below 20-45 ml/min/1.73m², as indicated by 1. Patients should be advised to maintain adequate hydration while taking these medications and to monitor for side effects such as genital mycotic infections, urinary tract infections, and volume depletion. SGLT2 inhibitors work by preventing glucose reabsorption in the kidneys, causing increased glucose excretion in urine, which helps lower blood glucose levels independent of insulin action. This mechanism also contributes to modest weight loss and blood pressure reduction, providing additional benefits beyond glycemic control for many patients with type 2 diabetes, as noted in 1 and 1. It is essential to consider the patient's kidney function and adjust the dosage accordingly to minimize potential adverse effects, as emphasized in 1 and 1. The use of SGLT2 inhibitors in patients with type 2 diabetes and chronic kidney disease has been recommended by several guidelines, including those from the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO), as stated in 1. Overall, the benefits of SGLT2 inhibitors in reducing cardiovascular and kidney risks make them a valuable treatment option for patients with type 2 diabetes, as supported by the evidence from 1, 1, and 1.
From the Research
Dosage of SGLT2 Inhibitors
The recommended dosages for SGLT2 inhibitors, including canagliflozin (Invokana), empagliflozin (Jardiance), dapagliflozin (Farxiga), and ertugliflozin (Steglatro), in patients with type 2 diabetes are as follows:
- Canagliflozin: 100 mg or 300 mg once daily 2, 3, 4, 5
- Empagliflozin: 10 mg or 25 mg once daily 6
- Dapagliflozin: 5 mg or 10 mg once daily 6
- Ertugliflozin: 5 mg or 15 mg once daily 6
Efficacy and Safety
Studies have shown that these dosages are effective in reducing HbA1c, fasting plasma glucose, and body weight, and are generally well tolerated in patients with type 2 diabetes 2, 3, 6, 4, 5.
- Canagliflozin 100 mg and 300 mg provided dose-related decreases from baseline in HbA1c of -0.81% and -1.11% at 52 weeks 4
- Ertugliflozin 5 mg and 15 mg were more effective than dapagliflozin 5 mg and 10 mg in reducing HbA1c in patients with type 2 diabetes 6
- Intensifying the dose of canagliflozin from 100 mg to 300 mg daily resulted in significant reductions in HbA1c and weight in patients with type 2 diabetes 5
Adverse Events
The most common adverse events associated with SGLT2 inhibitors include genital mycotic infections, adverse events related to osmotic diuresis, and volume depletion 2, 3, 4, 5.