SGLT2 Inhibitor Medications
The FDA-approved SGLT2 inhibitors available in the United States are empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro). 1
Currently Available SGLT2 Inhibitors
FDA-Approved Agents in the U.S.
- Empagliflozin (Jardiance) - Available in 10 mg and 25 mg tablets, FDA-approved to reduce cardiovascular death in adults with type 2 diabetes and established cardiovascular disease 2, 1, 3
- Canagliflozin (Invokana) - Available in 100 mg and 300 mg once daily dosing, FDA-approved to reduce risk of MI, stroke, CV death, and end-stage kidney disease in patients with diabetic nephropathy 2, 1, 4
- Dapagliflozin (Farxiga) - Standard dosing of 10 mg once daily, FDA-approved to reduce hospitalization for heart failure and cardiovascular death in both diabetic and non-diabetic patients with heart failure 2, 1, 5
- Ertugliflozin (Steglatro) - Available as an SGLT2 inhibitor option, though with less extensive cardiovascular outcomes data compared to the other three agents 1, 6
Investigational Agent
- Sotagliflozin - A dual SGLT1/SGLT2 inhibitor studied in the SOLOIST-WHF trial, showing benefits in patients with type 2 diabetes recently hospitalized for worsening heart failure, though not yet FDA-approved for routine use 7, 8
Mechanism Distinguishing These Agents
- High SGLT2 selectivity: Dapagliflozin, empagliflozin, and ertugliflozin are the most selective inhibitors for SGLT2 compared to SGLT1 9
- Moderate SGLT1 activity: Canagliflozin has greater SGLT1 inhibition, which affects intestinal glucose absorption in addition to renal effects 9
- Dual inhibition: Sotagliflozin inhibits both SGLT1 and SGLT2, providing combined intestinal and renal glucose modulation 9
Common Pitfalls to Avoid
- Do not assume all SGLT2 inhibitors have identical cardiovascular outcome data - empagliflozin and canagliflozin have the strongest evidence for reducing major adverse cardiovascular events (MACE) in patients with established atherosclerotic cardiovascular disease 1
- Canagliflozin has been associated with increased amputation risk and bone fractures in some trials, while empagliflozin and dapagliflozin have not shown these signals 1
- Do not discontinue SGLT2 inhibitors when glucose-lowering efficacy declines at lower eGFR levels, as cardiovascular and renal benefits persist even when glycemic effects are minimal 9