SGLT-2 Inhibitors Can Be Taken With or Without Food
SGLT-2 inhibitors can be taken with or without food as their absorption is not significantly affected by food intake. 1, 2, 3
Evidence from Drug Labels and Guidelines
The FDA-approved drug label for empagliflozin (Jardiance) clearly states that it can be "taken in the morning, with or without food" 1. Similarly, dapagliflozin's label indicates that "dapagliflozin can be administered with or without food" as food does not alter its overall absorption to a clinically meaningful degree 2.
This flexibility in administration timing is advantageous for patients as it:
- Improves medication adherence
- Allows integration into various daily routines
- Reduces barriers to consistent use
Pharmacokinetic Considerations
Research specifically examining the effect of food on empagliflozin pharmacokinetics found that:
- Food had no clinically relevant effect on the overall drug exposure (AUC)
- While maximum plasma concentration (Cmax) decreased when taken with food, this reduction was not considered clinically meaningful 3
Administration Recommendations
General Administration:
- SGLT-2 inhibitors can be taken at any time of day, with or without meals
- Consistency in timing is helpful for establishing a routine
- Morning administration is often recommended to minimize nighttime urination effects
Special Considerations:
- Perioperative setting: SGLT-2 inhibitors should be omitted the day before and the day of a procedure to reduce risk of ketoacidosis 4
- For patients on very low-energy/liver reduction diets: SGLT-2 inhibitors should be stopped at the commencement of the diet 4
Potential Side Effects and Management
SGLT-2 inhibitors may cause:
- Genitourinary tract infections - most common side effect 4, 5
- Volume depletion - particularly in older adults or those on diuretics 4
- Risk of ketoacidosis - rare but serious 4, 6
While food intake doesn't affect drug efficacy, staying well-hydrated is important when taking SGLT-2 inhibitors to minimize risk of volume depletion.
Considerations for Special Populations
Older Adults:
- SGLT-2 inhibitors are administered orally, which may be convenient for older adults 4
- Side effects such as volume depletion, urinary tract infections, and worsening urinary incontinence may be more common among older people 4
- Careful monitoring is recommended when initiating in elderly patients
Conclusion
SGLT-2 inhibitors offer flexibility in administration with respect to food intake. The evidence from drug labels and clinical research supports that these medications can be taken with or without food without significant impact on their efficacy. This characteristic makes them a convenient option for diabetes management, though appropriate monitoring for side effects remains important.