Are there any Sodium-Glucose Linked Transporter 2 inhibitors (SGLT2i) that do not contain milk as a preservative?

SGLT2 Inhibitors Without Milk as a Preservative

None of the currently available SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and sotagliflozin) contain milk as a preservative based on the available evidence.

Available SGLT2 Inhibitors and Their Formulations

• The main SGLT2 inhibitors available for clinical use include dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and sotagliflozin 1
• These medications are formulated as oral tablets and do not require milk or dairy-based preservatives for stability 1
• SGLT2 inhibitors work by inhibiting glucose reabsorption in the proximal renal tubules, which is independent of any dairy-based components 1

Considerations for Patients with Dairy Concerns

• For patients with dairy allergies or lactose intolerance, all currently available SGLT2 inhibitors appear to be suitable options 1
• The selection of a specific SGLT2 inhibitor should be based on:
  • Renal function (most require dose adjustment when eGFR <45 mL/min/1.73m²) 1
  • Cardiovascular risk profile (empagliflozin, dapagliflozin, and canagliflozin have proven cardiovascular benefits) 2, 3
  • Presence of heart failure or chronic kidney disease 1, 2

Clinical Efficacy and Safety Considerations

• All SGLT2 inhibitors reduce HbA1c by approximately 0.5-1.0% 1, 4
• These medications offer additional benefits beyond glucose control:
  • Weight reduction of 1.5-3.5 kg 1
  • Blood pressure reduction of 3-5 mmHg systolic 1
  • Cardiovascular and renal protection 1, 2
• Common side effects include:
  • Genitourinary tract infections 1
  • Risk of volume depletion 1, 2
  • Rare but serious risk of euglycemic diabetic ketoacidosis 5

Practical Prescribing Tips

• SGLT2 inhibitors can be initiated in patients with eGFR ≥20 mL/min/1.73m² 1, 2
• Expect an initial reversible decline in eGFR of 3-5 mL/min/1.73m² in the first 4 weeks 2
• Implement sick day protocols: hold SGLT2 inhibitors during acute illness, especially with nausea, vomiting, or diarrhea 1, 2
• Consider proactive dose reduction of diuretics in patients at high risk for volume depletion 2
• Daily hygiene measures can reduce the risk of genital mycotic infections 2

Specific SGLT2 Inhibitor Considerations

• Dapagliflozin and empagliflozin are preferred for patients with heart failure 2, 3
• Canagliflozin has been associated with a potential increased risk of lower-extremity amputation in some studies 4
• Ertugliflozin has a longer half-life (16 hours) compared to some other SGLT2 inhibitors, allowing for once-daily dosing 6, 7
• Sotagliflozin has dual SGLT1/SGLT2 inhibition properties 1