Ertugliflozin and Liver Enzyme Elevations in Dogs
Based on the available evidence, there is no specific data showing that ertugliflozin causes liver enzyme elevations in dogs. While SGLT2 inhibitors like ertugliflozin have been studied extensively in humans, the evidence does not include specific information about liver enzyme effects in canine patients.
What We Know About Ertugliflozin
- Ertugliflozin is a selective SGLT2 inhibitor approved for treatment of type 2 diabetes mellitus in humans 1
- It belongs to the same class as dapagliflozin, empagliflozin, and canagliflozin 1
- In humans, when liver enzyme elevations occur with ertugliflozin, they typically resolve within 1-4 months after discontinuation of the medication 2
Liver Enzyme Monitoring in Humans Taking Ertugliflozin
- For human patients taking ertugliflozin who develop elevated liver enzymes ≥3 times the upper limit of normal (ULN), holding the medication and repeating liver function tests within 48-72 hours is recommended 2
- The decision to continue or discontinue ertugliflozin in humans should be based on the magnitude of enzyme elevation, presence of symptoms suggesting liver injury, and availability of alternative glucose-lowering medications 2
Known Hepatotoxic Medications in Dogs
- Several medications have been documented to cause hepatotoxicity in dogs, including:
- Trazodone (case report of suspected hepatotoxicity with progressive increased liver enzyme activity) 3
- CCNU (lomustine) - causes delayed, cumulative dose-related, chronic hepatotoxicity that can be fatal 4
- Phenobarbital - long-term use can cause increases in serum ALP, ALT, and GGT, though this may reflect enzyme induction rather than hepatic injury 5
- Diethylcarbamazine/oxibendazole and trimethoprim/sulfadiazine have also been reported to cause hepatic injury in companion animals 6
Clinical Implications
- There is no specific evidence in the provided literature that ertugliflozin causes liver enzyme elevations in dogs
- When monitoring dogs for drug-induced hepatotoxicity, clinicians should consider:
- Serial monitoring of liver enzymes (ALT, ALP, GGT) 3, 5
- Evaluation of liver function parameters (albumin, bile acids, bilirubin) 5
- Ultrasound examination of the liver to assess for changes in echogenicity or architecture 5
- Liver biopsy for definitive diagnosis of drug-induced hepatopathy when indicated 3, 4
Conclusion
While ertugliflozin has been studied in humans with type 2 diabetes, there is no specific evidence in the provided literature regarding its effects on liver enzymes in dogs. Veterinary professionals should be aware of medications known to cause hepatotoxicity in dogs and implement appropriate monitoring when using these agents.
Human Medical Insights
- In humans, SGLT2 inhibitors including ertugliflozin have been tested in non-alcoholic fatty liver disease (NAFLD), but these studies have been small and do not examine the effect of these agents on liver histology 1
- For human patients who develop significant liver enzyme elevations on ertugliflozin, switching to a GLP-1 receptor agonist may be appropriate 2
Human guidelines should not be directly extrapolated to veterinary patients without specific evidence supporting safety and efficacy in the target species.