From the Guidelines
The currently available SGLT-2 inhibitors for clinical use are dapagliflozin, empagliflozin, and canagliflozin, which reduce glucose levels by inhibiting renal tubular SGLT2 and have been shown to reduce HbA1c levels, body weight, and systolic blood pressure, while also reducing the risk of major cardiovascular adverse events, renal events, and hospitalization rates for heart failure 1.
Key Characteristics of SGLT-2 Inhibitors
- Reduce glucose levels by inhibiting renal tubular SGLT2, promoting urinary glucose excretion
- Can reduce HbA1c levels by approximately 0.5% to 1.0%
- Can reduce body weight by 1.5 to 3.5 kg and lower systolic blood pressure by 3 to 5 mmHg
- Do not increase the risk of hypoglycaemia when used alone
Important Considerations for Clinical Use
- The dose of SGLT-2 inhibitors should be reduced in patients with moderate renal impairment and discontinued in severe renal impairment
- Common adverse effects include genitourinary tract infections, with rare adverse reactions including increased risk of ketoacidosis, acute kidney injury, bone fracture, and need for toe amputation (canagliflozin) 1
Clinical Applications
- Primarily indicated for type 2 diabetes management
- May have expanded indications for heart failure and chronic kidney disease regardless of diabetes status, as supported by recent evidence 1
From the FDA Drug Label
Dapagliflozin, an inhibitor of SGLT2, is described chemically as D-glucitol, 1,5-anhydro-1-C-[4-chloro-3-[(4-ethoxyphenyl)methyl]phenyl]-, (1S)-, compounded with (2S)-1,2-propanediol, hydrate (1:1:1).
- SGLT-2 inhibitors list:
- Dapagliflozin 2
- Other SGLT-2 inhibitors are not mentioned in the provided drug labels.
- Note: The provided drug labels only mention dapagliflozin as an SGLT-2 inhibitor.
From the Research
SGLT-2 Inhibitors List
The following SGLT-2 inhibitors are available for clinical use:
- Canagliflozin 3, 4, 5
- Dapagliflozin 3, 4, 6, 5, 7
- Empagliflozin 3, 4, 6, 5
- Ertugliflozin 3
- Sotagliflozin 3
Mechanism of Action and Clinical Use
SGLT-2 inhibitors work by blocking the reabsorption of filtered glucose in the kidney, increasing urinary glucose excretion and reducing blood glucose levels 7. They are used in the treatment of type 2 diabetes mellitus, and have been shown to reduce the risk of heart failure hospitalization and cardiovascular death in patients with type 2 diabetes and heart failure 3, 4.
Adverse Effects and Interactions
Common adverse effects of SGLT-2 inhibitors include genital mycotic infections, urinary tract infections, and events linked to volume depletion 4, 5, 7. There is also a concern about the risk of ketoacidosis and bone fractures 4. Drug-drug interactions with SGLT-2 inhibitors have been studied, and it has been found that they do not significantly influence the pharmacokinetic parameters of other glucose-lowering agents or cardiovascular agents commonly used in patients with type 2 diabetes 5. However, drugs that could specifically interfere with the metabolic pathways of SGLT-2 inhibitors may result in significant changes in the exposure of SGLT-2 inhibitors 5.