From the Guidelines
Yes, a patient who developed a yeast infection can generally be retried on SGLT2 inhibitors after the infection has been successfully treated. Before restarting, ensure the yeast infection has completely resolved with appropriate antifungal treatment such as fluconazole 150 mg as a single dose or topical antifungals like clotrimazole or miconazole for 7-14 days 1. When reinitiating the SGLT2 inhibitor (such as empagliflozin, dapagliflozin, or canagliflozin), start with the standard dosing as previously prescribed. To prevent recurrence, advise patients on preventive measures including:
- Proper genital hygiene
- Wearing loose cotton underwear
- Avoiding prolonged moisture in the genital area
- Promptly treating any symptoms of infection Yeast infections occur with SGLT2 inhibitors because these medications cause glucose excretion in the urine, creating a favorable environment for fungal growth 1. Despite this risk, the glycemic and cardiorenal benefits of SGLT2 inhibitors often outweigh this manageable side effect for most patients with type 2 diabetes or heart failure 1. It is essential to weigh the benefits of SGLT2 inhibitors against the potential risks and to closely monitor patients for any signs of infection or other adverse effects 1.
The most recent and highest quality study, published in 2022, supports the use of SGLT2 inhibitors in patients with type 2 diabetes and chronic kidney disease, with a significant reduction in the risk of cardiovascular events and kidney disease progression 1. Therefore, reinitiating SGLT2 inhibitors in patients who have developed a yeast infection is a reasonable approach, as long as the infection has been adequately treated and preventive measures are taken to minimize the risk of recurrence.
From the Research
Patient Considerations for Retrying SGLT2 Inhibitors
- Patients who developed yeast infections while on SGLT2 inhibitors can be retried on these medications, but with careful consideration of their individual risk factors and close monitoring for signs of infection recurrence 2, 3.
- The decision to retry SGLT2 inhibitors should be based on the severity of the previous infection and the patient's overall health status, including the presence of any underlying urogenital tract abnormalities 4, 5.
- Patients with a history of severe or recurrent genital mycotic infections may need to avoid SGLT2 inhibitors altogether, especially if they are female or have other risk factors for these infections 3.
Prevention and Management Strategies
- Educating patients about the risks of genital mycotic infections and providing guidance on personal hygiene practices can help reduce the incidence of these infections 6, 3.
- Mild cases of candidiasis can often be managed without discontinuing SGLT2 inhibitor therapy, but more severe infections may require cessation of the medication 2, 4.
- Healthcare professionals should be aware of the increased risk of genital mycotic infections associated with SGLT2 inhibitors and take steps to prevent and manage these infections in their patients 3.
Special Considerations
- Patients with urogenital tract abnormalities, such as those with a urostomy, may be at higher risk for complicated mycotic infections and should be carefully evaluated before initiating SGLT2 inhibitor therapy 5.
- The benefits of SGLT2 inhibitors in terms of cardiovascular and glycaemic control should be weighed against the potential risks of genital mycotic infections in each individual patient 2, 3.