Ertugliflozin Dosage and Use in Type 2 Diabetes Management
Ertugliflozin is recommended at doses of 5 mg or 15 mg once daily for treating type 2 diabetes, with both doses showing significant glycemic efficacy and cardiovascular benefits, particularly in reducing hospitalization for heart failure. 1
Recommended Dosing
- Ertugliflozin is available in two doses: 5 mg and 15 mg to be taken orally once daily 1
- The medication can be taken with or without food, as food does not significantly alter its effectiveness 1
- For patients with type 2 diabetes inadequately controlled on diet and exercise or metformin, both 5 mg and 15 mg doses provide clinically significant reductions in HbA1c 1, 2
- No dose titration is required when initiating therapy 1
Renal Function Considerations
- Ertugliflozin can be used without dose adjustment in patients with eGFR ≥45 mL/min/1.73 m² 1
- The medication should not be initiated in patients with eGFR <45 mL/min/1.73 m² due to reduced glycemic efficacy 3
- If eGFR falls persistently below 45 mL/min/1.73 m² after starting treatment, ertugliflozin should be discontinued 1
- The glycemic benefits of SGLT2 inhibitors, including ertugliflozin, are reduced at eGFR <45 mL/min/1.73 m² 3
Clinical Efficacy
- In monotherapy, ertugliflozin 5 mg and 15 mg significantly reduce HbA1c compared to placebo, with the 15 mg dose showing greater efficacy 1, 4
- As add-on therapy to metformin, ertugliflozin 5 mg was more effective than dapagliflozin 5 mg, and ertugliflozin 15 mg was more effective than both dapagliflozin 10 mg and empagliflozin 25 mg in reducing HbA1c 4
- Ertugliflozin demonstrated non-inferiority to glimepiride in HbA1c reduction when added to metformin therapy 5
- Beyond glycemic control, ertugliflozin provides additional benefits including weight loss and blood pressure reduction 5, 2
Cardiovascular Benefits
- The VERTIS CV trial demonstrated that ertugliflozin met non-inferiority criteria for major adverse cardiovascular events (MACE) compared to placebo 3
- Ertugliflozin showed a 30% reduction in hospitalization for heart failure (HR 0.70 [95% CI 0.54–0.90]) 3
- For patients with heart failure, SGLT2 inhibitors including ertugliflozin are recommended for both glycemic management and prevention of heart failure hospitalizations, regardless of baseline A1C 3
Safety Considerations
- The most common adverse effects include genital mycotic infections (9.1-12.2% in females and 3.7-4.2% in males) 6
- Increased urination (2.4-2.7%) and thirst (1.0-1.3%) are also reported with ertugliflozin use 6
- Volume depletion risk is increased in patients with eGFR <60 mL/min/1.73 m², those aged ≥65 years, or patients taking diuretics 6
- Ertugliflozin has a lower risk of hypoglycemia compared to sulfonylureas like glimepiride 5
- Monitor for rare but serious adverse events such as diabetic ketoacidosis and lower limb amputations 6
Practical Recommendations
- For most patients with type 2 diabetes, start with ertugliflozin 5 mg once daily 1
- Consider dose escalation to 15 mg daily if additional glycemic control is needed and the 5 mg dose is well tolerated 1, 2
- In patients with established cardiovascular disease or heart failure, ertugliflozin is particularly beneficial due to its effect on reducing hospitalization for heart failure 3
- For patients with chronic kidney disease (eGFR 20-60 mL/min/1.73 m²), SGLT2 inhibitors are recommended for slowing CKD progression and reducing cardiovascular events, but note that ertugliflozin should not be used when eGFR is <45 mL/min/1.73 m² 3, 1
- When initiating ertugliflozin, counsel patients about potential genital mycotic infections and increased urination 6
Special Populations
- In patients with moderate hepatic impairment, no dose adjustment is required 1
- Age, body weight, gender, and race do not significantly affect ertugliflozin pharmacokinetics, requiring no dose adjustments for these factors 1
- For patients at high risk of volume depletion (elderly, on diuretics, or with renal impairment), monitor closely when initiating therapy 6