SGLT2 Inhibitor Risks

SGLT2 inhibitor

SGLT2 inhibitor (Jardiance®, Invokana®, Forxiga®, etc) risks are in the spotlight again. SGLT2 stands for Sodium-glucose co-transporter-2.

SGLT2 inhibitor meds are getting more use now that most have proven Cardiovascular benefits….

Be ready with practical strategies to promote safe use.

Ketoacidosis. Some experts now advise stopping most SGLT2 inhibitors before surgery…and not restarting until oral intake is back to normal.

Ketoacidosis risk with SGLT2 inhibitors may also go up with factors such as dehydration, fasting, or reducing insulin doses.

Patients should promptly report symptoms of ketoacidosis…such as vomiting, fatigue, or trouble breathing.

Don’t rely on glucose checks or urine ketones to rule out ketoacidosis. Ketonuria may not be detectable with SGLT2 inhibitors…and they can cause ketoacidosis even if glucose is just slightly elevated.

Volume depletion. SGLT2 inhibitors may drop BP…due to diuresis. Hypovolemia can also lead to acute kidney injury…especially when used with ACEIs or ARBs, diuretics, NSAIDs, etc.

Encourage proper hydration…particularly in the elderly.

Suggest routine monitoring, such as checking serum creatinine before starting the med… 1 to 2 weeks later…and with dose increases.

SGLT2 inhibitors seem to protect the kidneys in the long run. But expect these meds to be stopped or held for significant bumps in serum creatinine…such as more than 30%.

Infection. SGLT2 inhibitors increase risk of genital yeast infections…and rarely, serious UTIs or Fournier’s gangrene.

Keep the perineal area clean…since these infections are likely from excess glucose in the urine.

Amputation. So far, this rare risk is seen with Invokana® (canagliflozin)…but a class effect can’t be ruled out yet.

Caution about using SGLT2 inhibitors in patients at high risk of amputation due to factors such as peripheral artery disease, neuropathy, or diabetic foot ulcers.

Implement proper foot care…inspecting their feet daily, cutting toenails properly, etc.

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